H-ECCO

About 25% of Inflammatory Bowel Disease (IBD) cases occur in individuals under 18 years old, and its incidence in childhood—especially early childhood—is rising globally. Paediatric IBD differs notably from adult-onset disease in clinical presentation, histology, severity and genetic background. Children are often diagnosed earlier in the disease course, before complications or classic mucosal changes appear. The disease tends to be more extensive and aggressive, partly due to longer cumulative inflammation and higher genetic and environmental susceptibility.

Drug-induced mucosal injury (DIMI) of the gastrointestinal (GI) tract can be a major clinical challenge because most agents can cause a variety of clinical, endoscopic and histological patterns of damage while a recognisable pattern of GI injury is rarely specific for a particular drug.

In June 2023, SciCom selected a joint proposal from Shaji Sebastian (then a ClinCom Member, now a Governing Board Member) and the H-ECCO Chair, Aart Mookhoek, addressing the present and future directions of artificial intelligence (AI) in IBD at the frontiers of imaging (endoscopy, radiology, histology), big data, predictive models, drug discovery and both ethical and regulatory considerations.

The treatment goals for Ulcerative Colitis (UC) are becoming increasingly stringent. Although not yet an official target, multiple studies have demonstrated that histological remission plays a crucial role in maintaining clinical remission, and experts emphasize the importance of comprehensive disease control incorporating histological outcomes.

At the 20th Congress of ECCO, held in Berlin, Germany from February 19 to 22, 2025, we organised the 10th H-ECCO IBD Masterclass. The aims of our meeting were to discuss the histopathological aspects of Inflammatory Bowel Disease (IBD), to highlight the multidisciplinary approach to the diagnostic process – also illustrated by the similar number of pathologists and gastroenterologists in the audience – and to look towards the future.

Inflammatory Bowel Disease (IBD) is characterised by chronic intestinal inflammation developing in genetically susceptible subjects in association with a dysregulated immune response, intestinal dysbiosis and environmental triggers.

The last decade has seen a dramatic increase in drugs available for the treatment of IBD. However, each of these novel biologics or small molecules achieves disease remission in only a relatively small proportion of patients [1].To date, implementation in clinical practice of evidence that assists in better evaluating the chance of therapy success in a particular patient for a particular drug is limited. Therefore, when choosing a drug for a patient with IBD who is starting therapy or needs to switch drugs, a trial-and-error approach may be unavoidable.

The theme of the 19th ECCO Congress in Stockholm, “Crossing borders in IBD”, was reflected in the aim of our educational meeting, which extended beyond the histopathological aspects of IBD. The objective was to highlight the collaboration between different specialisations, mirroring the multidisciplinary nature of our daily practice. This was clearly evident in the various topics covered during our initial session. Additionally, the Congress theme resonated in the diverse composition of our audience. Feedback revealed an equal division between pathologists and specialists from other fields.

Fibrosis and other connective tissue abnormalities are common in IBD, especially in Crohn’s Disease. The main clinical consequence is strictures, occurring most often in the small bowel or at the ileocaecal/ileocolic junction. Surgery may be necessary for stricture management. Fibrosis-predominant strictures are less responsive than inflammation-predominant strictures to medical therapy. However, there is overlap between these types. Also, smooth muscle abnormalities and other connective tissue changes are important. Possibly, there is a “chronic inflammation–fibrosis–smooth muscle ...

Very Early Onset Inflammatory Bowel Disease (VEO-IBD) is a complex subset of IBD that uniquely affects children under six years of age [1]. This category includes neonatal onset (within the first month of life), infantile onset (before two years) and early childhood onset (between two and six years) [2].

At the 18th Congress of ECCO in Copenhagen in 2023, many exciting projects on artificial intelligence (AI) were presented. Most of these projects focused on the role of AI in endoscopy. As a pathologist, I asked myself the following question: What about the role of AI in the histological evaluation of IBD?