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].

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.

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.

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].  

Fighting for growth in paediatric Inflammatory Bowel Disease

Amit Assa^1,2

Amit Assa © ECCO

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.

Johan Van Limbergen  © ECCO

Konstantinos Gerasimidis © ECCO

Johan Van Limbergen^1,2, 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]. 

David Wilson © ECCO

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. 

Lissy de Ridder © ECCO

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. 

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 3^rd Symposium in Rotterdam in 2014, hosted by Hankje Escher.

Jaroslaw Kierkus © ECCO

The 13^th Congress of ECCO is behind us: So many thoughts, and important new targets for research into therapy, diagnosis and management. Everything in one place, in wonderful Vienna.

From the point of view of the paediatrician, the Congress offered insights into numerous new predictive tools. It is not surprising that research is heading in this direction, for ultimately “to know” is halfway towards “to treat”. Looking more closely at this topic: What can we predict and by what means can we predict it?