© Alessandro Armuzzi
© Brigida Barberio
© Spyros Siakavellas
Dear IBD colleagues and Friends,
As COVID-19 restrictions persisted in most European countries and, indeed, beyond Europe, we were forced to admit at the last minute that our plans to meet in Vienna from February 16–19, 2022 for the 17th Congress of ECCO were not feasible, and that, as with the ECCO 2021 Congress, the meeting would have to be held virtually. Our aim has always been to host an in-person conference to allow the whole ECCO Community to meet and interact physically, to absorb the high-quality Congress content delivered through our wonderful keynote speakers, oral presentations, educational workshops and posters, and on that basis to improve research, developmental activities, collaborations and friendships in the field of Inflammatory Bowel Disease. Despite the challenges posed by the circumstances, we were very excited to have all our ECCO Family virtually onboard again, ready to play their part in “Navigating the Oceans of IBD”, which was the theme of the Congress.
This year, our vision of promoting the exchange of scientific knowledge among all who compose the ECCO Community around Europe and worldwide led us to cover a series of amazing topics. This offered an exciting way to “navigate” the science, leading up to the final 2022 ECCO Lecture, “A European IBD voyage”, which was given by Séverine Vermeire.
Thanks to our ECCO Office, the virtual ECCO 2022 Congress maintained almost all the original structure and content. Building on the experience of the previous meeting, the Virtual Platform helped to ensure smooth “navigation of the Oceans” for attendees, and we strongly believe that the voyage was full of novel insights and stimulating ideas in the field of IBD. Clinicians and researchers sailed through the vast expanses of the seas representing IBD knowledge, aiming for exciting new discoveries. Twelve topics were covered in the scientific sessions: “Developing environmental recipes for IBD”, “Keeping the patient at home: Is telemedicine the future?”, “Aiming high with treatment goals in IBD: The modern Icarus?”, “Modern monitoring of IBD”, “Histology in IBD: What the gastroenterologist should know”, “Do we see light at the end of fistula track?”, “COVID and non-COVID infections”, “IBD Horizons”, “From basic science to practical approach”, “Beyond the gut”, “Minimising malignancy risk” and “ECCO Lecture”. These scientific sessions were intersected by ten sessions of digital oral poster presentations.
We started with an overview of the role of the environment in IBD, exploring which environmental factors are modifiable and which interventional trials are able to address environmental factors in patients with IBD. The crucial issue of telemedicine in IBD was then addressed: the significance of telemedicine has increased dramatically during the pandemic, as it offers an alternative way of organising outpatient visits. Subsequently, we evaluated the optimal timing and method of therapeutic monitoring, exploring also what is the optimal way of diagnosing and monitoring fibrosis.
In an era in which it has become vitally important to achieve mucosal healing, and even more essential to achieve histological healing, we talked about the application of artificial intelligence to histology for the accurate assessment of remission and about the use of virtual chromoendoscopy artificial intelligence systems to detect endoscopic and histological remission. In this scenario, it has also become clear that it is essential to evaluate what is the best histological index in IBD.
Inevitably, we discussed new treatments that are expanding the horizons of IBD management, in particular covering the efficacy and safety of guselkumab in both UC and CD, of risankizumab in CD and of mirikizumab in UC clinical trials. In this setting, we tried to see light at the end of the fistula track, showing the efficacy and safety of filgotinib for the treatment of perianal fistulising CD and discussing other medical options.
Important lessons have been learned about IBD management during the COVID pandemic, and current knowledge on the use of vaccinations in IBD patients, especially those treated with biological therapies, and on other aspects was discussed.
Surely, a must-have in our Congress is an exciting session on basic science. This year, in discussing the topic “From basic science to practical approach”, we explored the significance of the revolution in OMICs and also the importance of some biomarkers in accurately predicting response to medications in IBD.
The session “Beyond the gut” was very interesting. The efficacy of upadacitinib in patients with UC and extraintestinal manifestations was demonstrated, and preliminary results were reported on the efficacy and safety of the combination of guselkumab and golimumab as induction therapy in patients with UC. An overview of ECCO Guidelines on sexuality, fertility, pregnancy and lactation was also provided.
Finally, an overview of ECCO Guidelines on IBD and malignancies addressed the topic of malignancy risk in patients treated or not with immunomodulatory therapies, and this included the provision of practical advice on skin cancers from a dermatologist.
So, basically, as with our previous annual meetings, the 17th Congress of ECCO proved to be a great and valuable experience! In case you missed it or would like to re-watch some of the content from the ECCO’22 Virtual Congress, we kindly ask you to visit the ECCO e-Library, where all of the recordings can be found (available at the end of May).
For those of you who are extra busy, we thought that a summary of the ten best abstracts (presented as digital oral presentations) from the Congress, as selected by our experts, would be of particular interest. This summary is provided below.
Stay safe! We look forward to meeting again in person next year in Copenhagen!
Alessandro, Brigida and Spyros
The winners of the awards for the ten best DOPs were:
DOP07: CHRONIC ABDOMINAL PAIN IN IBD PATIENTS IN REMISSION: REAL-WORLD DATA ON CONTRIBUTING FACTORS
Ashkan Rezazadeh Ardabili, Maastricht, the Netherlands
In this clinical study, Ardabili et al. aimed to investigate the aetiology of chronic abdominal pain in patients in whom disease was in remission.
Using data from a sizeable real-world multicentre cohort with the help of myIBDcoach, a remote monitoring platform, the authors investigated clinical, lifestyle and psychosocial factors. Chronic abdominal pain in IBD in remission was defined as an abdominal pain score ≥3 (on a ten-point numerical rating scale) at ≥1/3 of all assessments combined with faecal calprotectin <150 µg/g in 90 days around periodic assessments. A multivariable logistic regression analysis identified associations between chronic abdominal pain and female sex, shorter disease duration (<10 years), higher BMI, higher levels of stress, fatigue and life events.
This study may shed some light on the pathogenesis of a distressing symptom for IBD patients which may persist even with good disease control.
DOP14: VALIDATION OF A NEW OPTICAL DIAGNOSIS TRAINING PLATFORM TO IMPROVE DYSPLASIA CHARACTERISATION IN INFLAMMATORY BOWEL DISEASE (OPTIC-IBD): A MULTICENTRE RANDOMISED CONTROLLED STUDY
Richard James Michael Ingram, Alberta, Canada
Detecting dysplasia is crucial in the endoscopic follow-up of IBD. However, there is no formal training in regard to this, even in specialised tertiary centres.
Ingram et al. are in the process of developing and validating an online training platform to optimise the diagnosis of dysplastic lesions. This platform, called OPTIC-IBD, has been designed as an interactive, self-directed, multimodality learning module with participants including endoscopists of variable experience from multiple centres around the world. A planned interim analysis exhibited improvements in accuracy, precision and confidence in the diagnosis of dysplasia for endoscopists who trained with the OPTIC-IBD platform.
This exciting piece of work aims, when finished, to provide a systematic and validated training resource that will lead to better outcomes in the detection of dysplasia in IBD.
DOP22: CLINICAL, BIOCHEMICAL AND ENDOSCOPIC DISEASE ACTIVITY OF INFLAMMATORY BOWEL DISEASES ARE NOT ASSOCIATED WITH THE SEVERITY OR LONG-TERM OUTCOMES OF COVID-19 – A DANISH PROSPECTIVE POPULATION-BASED COHORT STUDY
Mohamed Attauabi, Hvidovre, Denmark
The COVID-19 pandemic and its association with IBD was understandably a hot topic at this year’s Congress.
In a well-designed prospective, population-based cohort study from Denmark, Attauabi et al. explored the possible presence of a correlation between the severity of COVID-19 disease and disease activity in IBD. Using the Danish COVID-19 IBD Database, which covers the whole of the Danish IBD population, and after performing extensive analyses, Attauabi et al. detected no association between different parameters of UC and CD activity (clinical, biochemical and endoscopic) and the severity of COVID-19 infection.
The results from this study show that risk stratification of IBD patients affected by COVID-19 may be independent of their underlying disease activity.
DOP33: ROLE OF ADHERENT AND INVASIVE E. COLI IN CROHN’S DISEASE: LESSONS FROM THE POSTOPERATIVE RECURRENCE MODEL
Anthony Buisson, Clermont-Ferrand, France
In this study from France, Buisson et al. utilised the REMIND prospective multicentre cohort of CD patients with ileocaecal resection to examine the possible role of adherent and invasive E. coli (AIEC) bacteria in the development of CD. This was done by using the postoperative recurrence model. They reported that AIEC infection seems to confer a higher risk for ileal lesions and endoscopic recurrence of the disease.
These results suggest that AIEC may play an important role in the early stages of the pathogenesis of ileal CD.
DOP40: IMPACT OF CORTICOSTEROID USAGE ON EFFICACY AND SAFETY OUTCOMES IN PATIENTS RECEIVING UPADACITINIB FOR ULCERATIVE COLITIS
Timothy Raine, Cambridge, United Kingdom
Raine et al. presented the results from a post-hoc analysis of the use of corticosteroids in patients with moderately to severely active UC who were receiving upadacitinib as part of the Phase 3 trials U-ACHIEVE Induction, U-ACCOMPLISH and U-ACHIEVE Maintenance.
The aim was to assess the effect of baseline steroid use on the efficacy and safety of upadacitinib. The previously agreed upon induction and maintenance endpoints as well as safety data were stratified according to baseline steroid use.
The analysis confirmed that in patients with UC, upadacitinib is superior to placebo in achieving steroid-free remission, while baseline steroid use did not confer any apparent efficacy benefit and was also associated with increased adverse effects such as opportunistic infection.
These results imply that using upadacitinib without concurrent steroid use may be a viable future strategy in establishing early disease control in patients with moderately to severely active UC.
DOP48: HEDGEHOG SIGNALLING CONTROLS TH17 DIFFERENTIATION TO DRIVE INTESTINAL INFLAMMATION AND IS A DRUGGABLE TARGET FOR THE TREATMENT OF IBD
Joachim Hanna, Cambridge, United Kingdom
In the field of basic science, a very exciting study came from Hanna et al., who examined the role of hedgehog signalling in the modulation of Th17 differentiation and effector function. Th17 cells have been established as key players in the immunological processes that are implicated in the pathogenesis of IBD. The authors, using specific knockout mouse models and bioinformatics analyses, reported that hedgehog signalling seems to constitute an important pathway in the regulation of Th17 cell differentiation, mainly via the effect of the Gli3 transcription factor.
Given the fact that hedgehog signalling has been shown to be readily manipulated by highly selective small molecule inhibitors, these results open the way for the potential use of these inhibitors in the management of IBD.
DOP59: DEVELOPMENT OF A NOVEL ULCERATIVE COLITIS (UC) ENDOSCOPIC ACTIVITY PREDICTION MODEL USING MACHINE LEARNING (ML)
David Rubin, Chicago, United States
Machine learning (ML) promises to be an innovation that will revolutionise our use of endoscopy in the assessment of IBD. In this study, Rubin et al. went a step further, adding in deep human annotation in a machine learning model by training it on endoscopic Mayo Score features, using previously centrally read endoscopies from a phase 2 trial for mirikizumab in patients with UC.
This improved ML model exhibited excellent results in discriminating between levels of endoscopic activity and distinguishing clearly between active and inactive disease. Similar models may be helpful in achieving an improved level of objectivity in endoscopic assessments in large clinical trials, thus allowing for more robust conclusions.
DOP69: LONG-TERM OUTCOME OF INFANTILE AND VERY EARLY ONSET IBD: A MULTI-CENTER STUDY FROM THE IBD PORTO GROUP OF ESPGHAN
Anat Guz Mark, Petah Tikva, Israel
In this international multicentre study in a paediatric IBD population, conducted under the auspices of the IBD Porto group of ESPGHAN, Guz Mark et al. examined the characteristics and long-term outcomes of very early onset IBD (< 6 years) and infantile IBD (< 2 years).
The authors reported that after at least two years of follow-up of 243 patients with IBD (CD 30%, UC 59%, IBDU 11%, 28% with infantile diagnosis), long-term outcomes seemed to be fair, with low rates of complications or need for surgical interventions. On the other hand, those patients with a diagnosis of infantile IBD appeared to exhibit a more difficult to manage phenotype with severe clinical features and a lower response rate to induction therapy for IBD.
These results highlight the need for increased awareness of the possibility of IBD development in the paediatric population even in infancy and the need for a structured and careful approach and appropriate follow-up in this unique patient cohort.
DOP78: COMPARATIVE STUDY OF THE EFFECTIVENESS OF VEDOLIZUMAB VERSUS USTEKINUMAB AFTER ANTI-TNF FAILURE (VERSUS-CD)
María José García, Santander, Spain
Patients who have failed anti-TNF therapy constitute one of the most difficult to manage subgroups in IBD. Thus, there is great interest in determining which are the best biologic agents for effective disease management in this population. In this study, José García et al. aimed to explore the retention rate of ustekinumab compared to vedolizumab in CD patients after anti-TNF failure as well as the effectiveness and safety of these treatments.
The authors used the ENEIDA registry, which is a prospectively maintained Spanish database. A total of 755 patients from 30 different centres were included (195 in the vedolizumab cohort and 560 in the ustekinumab cohort). After a median of 20 months (IQR 7.4–30) of follow-up, the survival rate for ustekinumab therapy was higher than for vedolizumab although it was relatively high (>40%) for both groups. This was confirmed after applying appropriate propensity matching scores. Adverse events were similar in the two groups.
Encouragingly, these real-world data show that a relatively high proportion of CD patients who received ustekinumab or vedolizumab after anti-TNF failure maintained these drugs in the medium to long term. Nevertheless, ustekinumab seems to be more effective than vedolizumab in this clinical scenario.
Monitoring of monoclonal antibody clearance seems to be a potentially useful approach in predicting treatment outcomes in IBD. Wang et al. aimed to assess whether the monitoring of infliximab and ustekinumab clearance in CD patients could be of value in the clinical management of IBD.
Data were obtained from a total of 188 patients (108 treated with infliximab and 80 with ustekinumab). Endoscopic remission (CD Endoscopic Index of Severity <3) and endoscopic response (≥50% decrease from baseline in simple endoscopic score for CD) were assessed at weeks 12 and 24 of treatment. A priori and a posteriori prediction models were used to assess predictive value.
The results of the analysis indicated that lower infliximab and ustekinumab clearance during the early induction phase are predictive of better endoscopic outcomes. This was true for both absolute clearance and clearance relative to baseline. More specifically, for ustekinumab the authors suggest that clearance monitoring may even be superior to standard therapeutic drug monitoring in predicting endoscopic response 6 months post treatment initiation.
These findings are suggestive of a possible expanded role for the monitoring of drug clearance in the clinical management of CD patients, especially for the target of endoscopic remission.