Report on the 6th D-ECCO Workshop at ECCO'21

The chair of D-ECCO, Marjo Campmans-Kuijpers, welcomed the participants and outlined D-ECCO Activities during the past year and upcoming opportunities, including two D-ECCO Committee vacancies and the D-ECCO Travel Award. The first speaker of the scientific session, Arie Levine, a paediatric gastroenterologist from Israel and a former D-ECCO Committee Member, gave a remarkable overview of the current knowledge on food additives and IBD. He highlighted the mechanistical pro-inflammatory effects of maltodextrin, carrageenans, gums and emulsifiers on the epithelial layer and the gut microbiome, and the wide use of these additives in the food industry.

The next talk was given by me (Lihi Godny, dietitian from Israel) and focussed on personalised nutrition in patients with IBD. As no single “IBD diet” can be recommended to all patients, dietary recommendations should be personalised. I reviewed the clinical characteristics that can currently be implemented in the clinic and the future potential use of biological phenotyping of patients, leading to the translation of microbiome and metabolomics data into dietary recommendations.

Marjo Campmans-Kuijpers, a dietitian from the Netherlands, comprehensively reviewed the emerging evidence on the role of fermented foods in IBD and overall health, covering all aspects from the history of fermentation to the currently available fermented foods like yogurt, kefir, sourdough bread and kimchi. She highlighted the effects of fermented foods on the microbiota and other health benefits and the need for more evidence to shift fermented foods from fad to fix.

The scientific session was closed by Eytan Wine, a paediatric gastroenterologist and D-ECCO Member from Canada, who discussed the future of using nutrition to alter the microbiome. Eytan provided an exciting look into the upcoming microbe-targeted diet therapy in IBD. He discussed how microbes involved in IBD pathogenesis can be manipulated by using microbiome-targeted food components like fibres, the use of diet to produce/deplete specific metabolites and the ways in which personal responses of patients can be implemented in the treatment of IBD.

Emma Halmos, a dietitian from Australia, opened the clinically focussed session with a very practical talk about nutritional assessment in IBD. She gave an overview of the different presentations of malnutrition, including protein energy malnutrition, myopenia, sarcopenia, myosteatosis and visceral adiposity. She discussed the pros and cons of assessment techniques, with a special focus on use of intestinal ultrasound to assess body composition. Emma highlighted that obesity and loss of muscle function become more prevalent in patients with IBD, with potential consequences for disease outcomes.

The next speaker, Catherine Wall, a dietitian from New Zealand, discussed the important topic of nutrition in pregnant IBD patients. She provided an excellent overview of the role of nutrition and dietary counselling in both the preconception and the pregnancy period. Catherine focussed on folic acid, iodine, iron, vitamin D and adequate intake of dietary fibres and demonstrated the importance of a balanced diet and adequate dietary supplementation in improving IBD-related pregnancy outcomes for both the mother and the fetus.

Dearbhaile O'Hanlon, a dietitian from the United Kingdom, closed the practical session with an outstanding talk about the dietary management of patients with orofacial granulomatosis (OFG). She provided an overview on OFG presentation and treatment options with a specific focus on a cinnamon- and benzoate-free diet. This is a highly specialised field and Dearbhaile gave an excellent demonstration of the critical role of the dietitian in the multidisciplinary care of patients with OFG.

The interactive session started with the presentation of two selected abstracts on nutrition, diet and IBD. Alice Day from Australia presented an abstract entitled “Food-related quality of life in adults with IBD is influenced by restrictive eating behaviour, disease activity and surgery: a prospective multi-centre study”. This was followed by an abstract presentation by Simona Gatti from Italy about the risk of eating disorders in Italian children and adolescents with IBD. Next, Emma Halmos from Australia and Mark Samaan, a gastroenterologist from the United Kingdom, debated whether emerging diets will replace medical therapy in IBD. Emma presented the dietitian’s perspective and demonstrated the efficacy of dietary therapies for induction and maintenance of remission. She pointed out the safety advantage of dietary therapy and discussed other uses of diet, such as for the treatment of malnutrition and disease complications and the prevention of IBD. On the other hand, Mark presented the physician’s perspective and highlighted the inconvenience of dietary therapies, the lack of robust clinical trial data and the unclear impact on long-term outcomes, in contrast to medical therapy. The session concluded with an interactive panel discussion (Drs. Wall, O’Hanlon, Halmos and Samaan), with multiple questions from the audience.

Despite being virtual, the 6th D-ECCO Workshop was highly successful and provided an up-to-date overview on the scientific and clinical aspects of dietary therapy in IBD. Alongside the D-ECCO Workshop, diet was discussed in multiple sessions at the 16th Congress of ECCO, including the N-ECCO School, a P-ECCO Educational Course entitled “Food for thought in IBD” and the plenary sessions. From a personal point of view, I’m excited to see that diet is now well recognised as a key player in the pathophysiology of IBD and that the role of dietitians in improving patient care is widely acknowledged. I look forward to seeing you all in person at the next ECCO Congress.

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