We are going through a hard time. The first cases of COVID-19 in Europe were reported during the ECCO Congress in Vienna. The world is facing a pandemic which is not easy to treat and for which the course cannot be predicted. As IBD physicians, we are used to manage a difficult disease but not a lockdown. The ECCO spirit will help us coping with social isolation, which is the opposite of the ECCO goal. Our organization will contribute to this fight by publishing weekly interviews of worldwide experts (link to interviews) telling us how to manage our patients and how to keep moving forward during this pandemic.
7,307 delegates attended the 15th Congress of ECCO in Vienna
The 15th Congress of ECCO – Inflammatory Bowel Diseases 2020, held on February 12-15, 2020 in Vienna, Austria, attracted a total number of 7,307 delegates from 102 different countries. Since the inaugural ECCO Congress in 2006 in Amsterdam, at which there were 350 delegates, participant numbers have steadily increased, as shown in the graph below. Despite the COVID-19 outbreak in the beginning of the year, we are happy that this high number of delegates had the chance to participate in the ECCO’20 Congress.
We hope you are all well and are keeping safe in the current climate.
It was great to see so many friends at the 15th ECCO congress in Vienna, which was a great success. We have a series of updates for you including a synopsis of the winning digital oral presentations, an introduction to the “Talking Global IBD” ECCO initiative and an introduction to the new ECCO App. Please get in touch via the ECCO Office if you’d like to see/read specific content in the next series of eNewsletters.
One of the main goals of ECCO is to promote IBD-related basic and clinical research as well as to foster interaction and productive collaboration among European research groups working in the IBD field. To achieve this goal, ECCO supports numerous funding schemes with different scopes including ECCO Fellowships, Grants, and Travel Awards.
The ECCO Congress offers an ideal opportunity to learn, share and interact. This was also the main purpose of the5th Basic ECCO: EduCational COurse for Industry, held on Wednesday, February 12, 2020. The course aimed to provide corporate and non-corporate members who have recently entered the field of IBD with an introduction to IBD, focussing on the clinical essentials and ‘need-to-knows’. 104 participants from 23 countries attended the course.
This year’s 7th ClinCom Workshop focussed on two main topics. The first session was devoted to sequencing and combination of different IBD treatments for IBD. The speakers addressed the possible biological implications of drug sequencing and the mechanistic changes in the inflammatory pathways.
The mission of ClinCom is to promote investigator-initiated studies among ECCO Members. The Committee welcomes submissions from investigators and national study groups and evaluates and critically appraises the quality, feasibility and practicality of each study proposal. The 5th IBD National Study Group Meeting, held on February 12 during the ECCO 2020 Congress, featured presentations from five investigators on proposals for high-quality collaborative studieswhich will be suitable for running across national study groups.
The Epidemiological Committee (EpiCom) organised the 5th EpiCom Workshop at the ECCO’20 Congress in Vienna. The delegates were welcomed by Marieke Pierik, who introduced the concept of patient-reported outcomes (PRO) with the aid of a clinical case. The discussion continued by examining discrepancies between what a treating physician defines and sees as a response to therapy and the perceptions of the treated patient. Physician and patient may hold different views on the effectiveness of a treatment, particularly if the physician bases the evaluation of treatment success solely on improvements in clinical, biochemical and endoscopic measurements, without considering the patient’s quality of life and wellbeing. Integration of PROs into the evaluation can play a pivotal role in overcoming this issue.
At ECCO 2020 two ultrasound workshops were held. The 2nd ECCO-ESGAR Basic Imaging Workshop was devoted to the basics of intestinal ultrasound (IUS) and MRI. In this workshop, gastroenterologists from ECCO who are experts in intestinal ultrasonography and radiologists from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) who are experts in IBD jointly provided delegates with a full immersion in imaging in IBD.
In 2020 the ECCO Endoscopy Workshop reached its 6th edition, and it has now become a mainstay of the educational activities of ECCO. Since 2019 the Endoscopy Workshop is a part of the ECCO-ESGAR Basic Imaging Workshop. The workshop was organised by the ECCO Education Committee (EduCom), and was devoted to and structured for physicians or colorectal surgeons who are specialists in IBD with at least some experience in endoscopy.
The 18th IBD Intensive Advanced Course took place before the ECCO Congress as the highlight of the educational programme, which runs in conjunction with the Congress.
This well-known course, which has been held almost since the inception of ECCO, took place once again, attracting a full attendance from Europe and elsewhere. Overall, 94 doctors attended the course from 37 countries and were treated to a comprehensive update on IBD.
The revised pipeline for updating of ECCO Guidelines was recently established. This pipeline envisages updates to the two main guidelines on treatment of Crohn’s Disease and Ulcerative Colitis in adults every 3 years. Other ECCO Guidelines will be updated approximately every 5 years. Having just completed publication of the first ECCO Guideline on treatment of Crohn’s Disease in adults employing GRADE methodology, work is now underway on a similar update to the main ECCO UC Guideline. Similar to the 2019 Crohn’s Disease Guideline, the updated UC Guideline will employ GRADE methodology to address most of the key questions, covering both medical and surgical treatments.
The 11th N-ECCO School in Vienna was attended by 74 participants from 25 countries, including dietitians and IBD Nurses. The School covered various IBD topics of interest to both nurses and dietitians who work with IBD patients. The aim was to enhance participants’ basic knowledge in IBD, enabling them to provide better support to IBD patients throughout Europe and beyond. The N-ECCO School has also come to serve as a great networking opportunity, allowing nurses and dietitians to share their experiences.
The 6th N-ECCO Research Forum was attended by 52 nurses active and/or interested in research. The Research Forum is arranged every second year and this year was opened by Wladzia Czuber-Dochan (United Kingdom), who also presented the winners of the N-ECCO Research Grant 2020: Simona Fourie (UK) and Katarina Pihl Lesnovska (Sweden).
The 14th N-ECCO Network Meeting was opened by Susanna Jäghult(Sweden), N-ECCO Chair. In total, 255nurses from across the world attended the meeting.
The first session focussed on presentations regarding “The IBD Nurse Education Programme”, which was performed and completed in Italy during 2018–2019. Palle Bager (Denmark) and Karen Kemp(United Kingdom) reported on the development of the programme and how it was conducted in Italy. Then, Simona Radice and Gionata Fiorino, both from Italy, described the country perspective on the programme. This aroused great interest among the audience and the second cycle is now in the pipeline.
On the evening of Wednesday, February 12, 16 nurses from 11 countries across Europe participated in our yearly N-ECCO National Representatives Meeting.
As the N-ECCO Committee Member responsible for the National Representatives, I welcomed the attendees, and this was followed by a short round of introductions. An exchange of nurses every 2–3 years is greatly encouraged by N-ECCO, but many countries nevertheless retain the same National Representatives for more than 3 years. New people tend to mean new ideas, although some countries have different service setups and getting new representatives is sometimes difficult.
D-ECCO, the Dietitians of ECCO, held its 5th Workshop as part of the 15th ECCO Congress in Vienna in February 2020. I will describe some of the highlights and main messages of the Workshop, which was attended by 104 registered delegates.
The 9th S-ECCO Masterclass (held in collaboration with the European Association of Coloproctology, ESCP) was organised during the 15th Congress of ECCO in Vienna. Thankfully, just before the coronavirus crisis!
As in previous years, it was a full-day masterclass, and once again it attracted a large number of participants, 149. This meant that in terms of attendance the S-ECCO Masterclass was second among all masterclasses and symposia, just after the N-ECCO Network Meeting.
The Histopathology Committee of ECCO (H-ECCO) is now more than 5 years old, having started as a new working group. It is an enthusiastic group that supports various activities and interacts well with other ECCO Committees. The most identifiable and consistent activity is the H-ECCO IBD Masterclass, a successful event attracting more than 70 delegates annually from Europe and further afield.
Bringing basic science from the bench to the bed, and back, can be challenging for both scientists and clinicians. In order to encourage young scientists and clinicians to collaborate and to approach similar scientific questions from a different – but joint – perspective, the Y-ECCO Basic Science Workshop was founded years ago. Every year, the Y-ECCO Committee invites outstanding senior experts to give a state of the art overview on hot topics in the field. Furthermore, these top-notch speakers not only moderate the discussions following abstract presentations but also inspire and stimulate full-time researchers and young clinicians to do basic science at the start of their careers.
The management of Ulcerative Colitis (UC) increasingly involves the use of a biologic agent. Placebo-controlled trials have demonstrated the efficacy of both adalimumab, a tumour necrosis factor (TNF) inhibitor, and vedolizumab, an integrin inhibitor. However, variation in study design makes comparison between such trials difficult. This is particularly evident when comparing rates of clinical remission in the placebo groups of different trials. For example, in the ULTRA 2 trial, which established the superiority of adalimumab over placebo in moderate to severe UC, the 52-week clinical remission rate in the placebo group was just 8.5% compared to 15.9% in GEMINI 1, the placebo-controlled trial of vedolizumab [1,2]. In the absence of head-to-head trials between biologics there is a lack of data to inform clinicians of the best choice of agent. VARSITY is the first head-to-head trial to compare the efficacy and safety of vedolizumab and adalimumab in moderate to severely active UC.
Therapeutic drug monitoring (TDM) of the anti-TNF monoclonal antibodies, infliximab and adalimumab, in patients with Inflammatory Bowel Disease is gradually being adopted into routine clinical practice in the United Kingdom  and United States . The aim of TDM, measuring an individual’s drug and anti-drug antibody levels, is to assess compliance, drug metabolism and immunogenicity with a view to guiding adjustments or changes in management in order to improve clinical outcomes1. TDM can be proactive, with routine measurement of drug level and anti-drug antibody regardless of clinical outcome, or reactive, with measurement of drug level and anti-drug antibody in the setting of loss of response . Compared to empirical dosing alone, TDM used reactively, at the time of loss of response to an anti-TNF treatment, improves durability of response and safety and leads to significant cost savings [4,5]. The evidence base supporting proactive over reactive TDM is, however, less clear. Two randomised controlled trials done in adults (TAXIT  and TAILORIX ) did not demonstrate any differences in biological, endoscopic or corticosteroid-free remission between groups, though these trials were limited by methodological limitations and isolating the effect of proactive TDM on defined outcomes was difficult. In contrast, multiple observational studies have concluded that there is less risk of treatment failure and relapse, higher rates of drug persistence and better clinical outcomes in patients who undergo proactive TDM compared to reactive TDM [8–11]. The authors aimed to add to this debate by carrying out a pragmatic, randomised controlled trial assessing whether proactive TDM is superior to reactive testing in children with Crohn’s Disease.
Anti-tumour necrosis factor-α (anti-TNF) has historically been the mainstay of biologic therapy in Inflammatory Bowel Disease (IBD). However, of those who initially respond to anti-TNF, almost 50% will suffer secondary loss of response (SLR) over subsequent years [1,2]. This SLR is primarily predicated on suboptimal anti-TNF trough levels, with or without detectable anti-drug antibodies (ADAs) . Furthermore the prospective, observational study by Kennedy et al. demonstrated that suboptimal anti-TNF trough levels at week 14 predicted ADAs, low trough levels and worse clinical outcomes . This risk was mitigated for both infliximab and adalimumab by the use of immunomodulators such as azathioprine. This corroborates the retrospective data from other cohorts showing how the addition of an immunomodulator can restore clinical response and favourable pharmacokinetics [5–7]. Remission rates when switching to a second anti-TNF have been shown to be lower when the reason to withdraw the first anti-TNF is SLR as compared to intolerance (45% vs 61%) . In the event that SLR to anti-TNF is due to immunogenicity, a switch to another anti-TNF is associated with a risk of ADA to this new therapy [9,10]. A number of patients will also be on anti-TNF monotherapy at the time of switching having de-escalated from previous combination therapy. We know that open-ended prescription of anti-TNF with azathioprine is not without additional risk, notably infection and lymphoma . Furthermore, de-escalation to anti-TNF monotherapy after a period of combination therapy has been shown in most studies not to impact on relapse rates (49% monotherapy versus 48% combination therapy) . It is in precisely this important group of patients that Roblin et al. sought to compare the use of azathioprine in combination with a second anti-TNF versus this second anti-TNF as monotherapy. Over a follow-up period of 2 years, the rates of clinical and immunogenic failure, and of adverse events, were compared.
Laurent Peyrin-Biroulet is Professor of Gastroenterology and head of the Inflammatory Bowel Disease (IBD) group at the Gastroenterology Department, University Hospital of Nancy, France. He is also the current President of the Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID). As of February 15, he has been the new President of ECCO and we interviewed him during the ECCO Congress in Vienna.
Number of meetings per year: We celebrate one national meeting a year with more than 400 attendees and three annual meetings for residents. We also have a meeting for nurses and a Young GETECCU meeting per year.
President and Secretary: Manuel Barreiro de Acosta and Yamile Zabana Abdo
National Representatives: Manuel Barreiro de Acosta (President) and Ana Gutierrez Casbas (Vice President)
Joined ECCO in:Manuel Barreiro in 2008 and Ana Gutiérrez in 2019
Incidence of IBD in the country: 16 cases/100.000 persons-years, 7.5 for Crohn´s disease, 8 for Ulcerative Colitis (UC) and 0.5 for unclassified IBD. These data come from our nationwide epidemiologic Spanish Study, EpidemIBD.
The satellite symposium sponsored by Tillotts Pharma was introduced by the Chair, Brian Feagan, Robarts Research Institute, Canada. The topics discussed were of unknown territory in areas where little research has been conducted up until now.