Monitoring in Paediatric IBD

Marina Aloi, P-ECCO Member

Marina Aloi 

In the last decade the traditional management of Inflammatory Bowel Disease (IBD), based on clinically guided treatment intensification, has been revised and the so-called treat-to-target (T2T) approach, focusing on objective and scheduled measures to monitor intestinal inflammation, has been implemented in clinical practice, both in adults and in children. The general idea behind such tight monitoring is to prevent or block intestinal damage related to persistent and uncontrolled inflammation, and to avoid long-term complications.

Posted in ECCO News, Committee News, Volume 16, Issue 4, P-ECCO


Pharmacokinetics of anti-TNFα agents in paediatric IBD: Is there any difference at all compared with adults?

Amit Assa, P-ECCO Member

Amit Assa 

Anti-tumor necrosis factor alpha (TNFα) therapy is frequently used in the treatment of Crohn’s Disease (CD) and Ulcerative Colitis (UC) in both adult and paediatric patients. Nevertheless, primary or secondary treatment failure of anti-TNFα treatment is not uncommon [1]. Both primary and secondary treatment failures are attributed either to pharmacokinetic, pharmacodynamic and immunogenic factors or to adverse events in response to the specific agent [2]. In recent years, loss of response (LOR) during anti-TNFα treatment has commonly been approached through the use of therapeutic drug monitoring involving measurement of infliximab or adalimumab trough concentrations (TC) and anti-drug antibodies (ADAs). Therapeutic drug monitoring of anti-TNFα agents enables proper stratification of LOR into a specific type of LOR, with corresponding adjustment of treatment. In children, in line with findings in adults, it has consistently been shown that higher drug TC is associated with higher efficacy [3] and that LOR is most commonly attributable to either low TC or the development of anti-drug antibodies [4].

Posted in ECCO News, Committee News, Congress News, P-ECCO, Volume 16, Issue 2


8th P-ECCO Educational Course at ECCO' 21

David Wilson, P-ECCO Chair

David Wilson

Although the relationship between IBD and nutrition is of longstanding interest, the attention paid to it has increased dramatically in recent years, with the inclusion of nutritional interventions in ECCO Guidelines on both paediatric and adult Crohn’s Disease (and of course many other IBD guidelines), bespoke publications such as the ECCO perioperative dietary therapy topical review and a flowering of clinical interest in Crohn’s Disease-specific diets.

This clinical interest in nutritional issues in IBD is also reflected in the exceptional interest in a December 2020 educational article in the UEG Journal “Mistakes in…” series, namely “Mistakes in nutrition in IBD and how to avoid them” by the ECCO Members Joe Meredith, Kostas Gerasimidis and Richard Russell (ueg.eu/a/268). Basic and translational scientific studies of the pathogenesis of IBD have increasingly evaluated the role of nutrition and particularly its interaction with the microbiome.

Posted in ECCO News, Committee News, Congress News, P-ECCO, Volume 16, Issue 1


COVID-19 and Paediatric Inflammatory Bowel Disease

David Wilson, P-ECCO Chair

David Wilson

Since the first reports in Wuhan, China in December 2019, the new coronavirus SARS-CoV-2 has resulted in over 40 million confirmed cases of COVID-19 globally with over 1 million deaths within just 10 months. Economies have been shattered, routine healthcare has been severely disrupted, and restrictions have been imposed on travel and social and family life in a previously unthinkable manner.

Posted in ECCO News, Committee News, Congress News, P-ECCO, Volume 15, Issue 4


Microbiome and diet: advances in the pathogenesis and treatment of Crohn’s Disease

Johan Van Limbergen, P-ECCO Member

Johan van Limbergen

Dietary advice in the management of IBD has evolved in recent years from having gastrointestinal symptom reduction as a goal to a more pathogenesis-focussed approach [1–4]. At present, dietary recommendations in adult Crohn’s Disease (CD) are limited to increasing dietary fibre by means of fruit and vegetables and decreasing processed foods [1]. The nutrition debate has long divided adult and paediatric CD care, from international guidelines all the way through to service provision arrangements, with growth failure being a common feature in paediatric CD and dietetic support being a mainstay of care in many children’s hospitals [5–7].  

Posted in ECCO News, Committee News, Congress News, P-ECCO, Volume 15, Issue 2


Fighting for growth in paediatric Inflammatory Bowel Disease

Amit Assa, P-ECCO Member

Fighting for growth in paediatric Inflammatory Bowel Disease

Amit Assa1,2

Amit Assa 2019
Amit Assa

Growth retardation is commonly seen in children diagnosed with Inflammatory Bowel Disease (IBD), mainly those with Crohn's Disease (CD). The aetiology of poor growth in children with IBD is multifactorial and includes malnutrition, poor intake, increased nutritional needs, elevated inflammatory cytokines, genetic factors (parental height, CD susceptibility genes) and corticosteroid therapy. Growth retardation may be present years before diagnosis of IBD, and it commonly persists despite disease-specific treatments, with implications for final adult height and consequent social and psychological burden.

Posted in ECCO News, Committee News, P-ECCO, Volume 14, Issue 3


Microbiome and diet are partners in CD pathogenesis and treatment

Johan Van Limbergen 2019
Johan Van Limbergen 
Konstantinos Gerasimidis wrc 2015
Konstantinos Gerasimidis

Johan Van Limbergen1,2, Konstantinos Gerasimidis3

Crohn’s Disease (CD) is increasing in incidence worldwide [1]. In spite of increased use of immune suppression, which has markedly changed the need for in-hospital care, paediatric CD remains associated with considerable morbidity as well as increased mortality [2, 3]. The onset of disease in childhood and adolescence often interferes with growth and development, both physically and psychologically. In a subset of patients, the progressive nature of disease may be associated with a fibrotic phenotype that does not respond adequately to the currently available immune suppressive medications, yet use of these medications is still associated with increased risk of myelosuppression, opportunistic infections, immune-mediated phenomena and malignancy [2, 4–6]. 

Posted in ECCO News, Committee News, P-ECCO, Volume 14, Issue 2


New Committee Members in P-ECCO

David Wilson, P-ECCO Chair

David WilsonDavid Wilson

The mission of the Paediatric Committee of ECCO is improving knowledge on paediatric-specific IBD issues as well as supporting and facilitating research into paediatric IBD. During the ECCO Congress in Copenhagen, P-ECCO said goodbye to Patrick van Rheenen and Jaroslaw Kierkus. We greatly thanked them for all their contributions to P-ECCO and welcomed two new members: Johan van Limbergen and Amit Assa

Posted in ECCO News, Committee News, Congress News, ECCO'19, P-ECCO, Volume 14, Issue 1


Challenges in using new drugs in children

Lissy de Ridder, P-ECCO Member

Lissy de Ridder
Lissy de Ridder

Paediatric Inflammatory Bowel Disease (IBD) accounts for 10%15% of all incident cases of IBD, while the incidence in children under 10 years old is rising most rapidly [1, 2]. Children and adolescents present with a more severe phenotype of disease and have both higher and unique risks (e.g. fistulising disease, growth failure, pubertal delay) and a longer disease duration, given that IBD is a lifelong disease. 

Posted in ECCO News, Committee News, P-ECCO, Volume 13, Issue 2


4th International Symposium on Paediatric Inflammatory Bowel Disease - PIBD 2017

David Wilson, P-ECCO Member

David Wilson
David Wilson © ECCO

The first International Symposium on Paediatric Inflammatory Bowel Disease (PIBD) took place in Rome in 2006 and was hosted by Salvatore Cucchiara. It was followed by the second PIBD Symposium in 2009 in Paris, hosted by Frank Ruemmele. Both were private initiatives. After a pause while plans to alternate PIBD Symposia between venues in Europe and North America were considered, the paediatric IBD Porto group of ESPGHAN took over all organisation. This resulted in the 3rd Symposium in Rotterdam in 2014, hosted by Hankje Escher.

Posted in ECCO News, Committee News, P-ECCO, Volume 13, Issue 1