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?

Richard Russell  ©  ECCO

The revision of the Paediatric UC Guideline for children has been carried out jointly by the ESPGHAN Porto IBD group and ECCO. This revised guideline has updated the previous separate guidelines on Acute Severe UC and Ambulatory UC [1,2] and combined them into one document. The guideline was developed on the basis of an intensive literature search and careful evidence grading; the Oxford levels of evidence were used for the latter purpose after it became clear that the guideline was being developed too soon for the use of GRADE methodology. A summary of all the evidence assimilated during the guideline development will be published as supplementary tables so that others can benefit from the intensive search without having to redo the work.