This new diagnostic consensus guideline is a joint project of the European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] that now merges the former ECCO-ESGAR Imaging Guideline and the former ECCO Endoscopy Guideline, also including laboratory parameters. It has been drafted by 30 ECCO and ESGAR members from 17 European countries.

This new diagnostic consensus guideline is a joint project of the European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] that now merges the former ECCO-ESGAR Imaging Guideline and the former ECCO Endoscopy Guideline, also including laboratory parameters. It has been drafted by 30 ECCO and ESGAR members from 17 European countries.

Management of patients with inflammatory bowel disease [IBD] has become increasingly complex, but at the same time very exciting and challenging. For a long time, surgery in IBD has been considered as a last resort, and although ‘multidisciplinary treatment’ has always been a popular term, involving a surgeon in daily practice was frequently limited to therapy-refractory patients. The most exciting change over the last few decades is probably the fact that involving a surgeon at an early stage of the disease is now considered good clinical practice, and is part of most quality-control parameters.

These guidelines provide a guide to clinicians managing children with UC and IBD-unclassified management to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

Background and aim: Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts.

This is the second Nurses European Crohn’s and Colitis Organisation [N-ECCO] Consensus Statements document addressing inflammatory bowel disease [IBD] nursing across Europe. N-ECCO continues to be an active member of the European Crohn’s and Colitis Organisation [ECCO], providing education and networking opportunities for nurses across Europe within three designated nursing sessions, N-ECCO Network Meeting, N-ECCO School and the N-ECCO Research Forum, in addition to e-learning and podcasts.

Introduction: One of the founding core activities of the European Crohn’s and Colitis Organisation [ECCO] is to educate gastroenterologists interested in inflammatory bowel disease [IBD]. The first ECCO Course on IBD for Junior Gastroenterologists was held in 2003, and will be held for the 15th time at the ECCO Congress 2017 in Barcelona. The first ECCO Educational Workshop took place in 2007, and since then 55 workshops have been organised in 40 countries around the globe, using the statements created in the ECCO evidence-based consensus processes as teaching material [for example the ECCO Crohn’s disease consensus1]. Finally, in 2013 ECCO launched e-CCO, the online learning platform with a mission to improve the care of patients with IBD in all its aspects by providing a comprehensive package of education for all health care professionals interested in IBD. The current e-CCO e-learning portfolio comprises 18 extensive e-courses based on the ECCO guidelines, and close to 40 original videos on basic IBD topics and current controversies in the treatment of IBD. The e-library is made up of presentations [on slides and on video] from the ECCO congresses, created and delivered by some of the foremost experts in IBD. With the increasing incidence of IBD in Europe and a growing interest in our activities, ECCO has decided to create the ECCO IBD Curriculum to serve as a backbone for its educational efforts, and also as a guide for interested gastroenterologists.

Introduction: Biosimilars of infliximab were first approved by the European Medicine Agency in 2013, based on pre-clinical studies on biosimilarity and on clinical data coming from two randomised controlled trials conducted in rheumatoid arthritis [RA] and ankylosing spondylitis [AS]. Initially the European Crohn’s Colitis Organisation [ECCO] raised some caution on the use of biosimilars.5 This cautious approach was also supported by several national inflammatory bowel disease [IBD] societies5–12 [Table 1]. An insufficient understanding of the characteristics and use of biosimilars became evident in a web survey among ECCO members in the same period.

The aim of this Consensus is to establish up-to-date standards for timing and methodology of Surgery in Crohn’s Disease.In cooperation with ESCP, ECCO Surgeons joined forces with Paediatricians as well and parts of this Guideline will cover paediatric content.  

This ECCO Topical Review of the European Crohn’s and Colitis Organisation [ECCO] focuses on the role of environmental factors with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.

This ECCO topical review of the European Crohn’s and Colitis Organisation [ECCO] focuses on the epidemiology, pathophysiology, diagnosis, management and outcome of the two most common forms of inflammatory bowel disease, Crohn’s disease and ulcerative colitis, in elderly patients. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.

Background: This European Crohn’s and Colitis Organisation [ECCO] topical review focuses on the transition of adolescents with inflammatory bowel disease [IBD] from child-centred to adult-oriented care. The aim was to provide evidence-supported, expert consensus for health professionals taking part in the transition.

Methods: An online survey determined the areas of importance for health professionals involved in the transition of adolescents with IBD. Thereafter an expert panel of nine paediatric and five adult gastroenterologists was formed to identify the critical elements of the transition programme, and to prepare core messages defined as ‘current practice points’. There is limited literature about transition, therefore this review is mainly based on expert opinion and consensus, rather than on specific evidence.

Results: A total of 21 practice points were generated before the first [online] voting round. Practice points that reached >80% agreement were accepted, while those that did not reach 80% agreement were refined during a consensus meeting and subjected to voting. Ultimately, 14 practice points were retained by this review.

Conclusion: We present a consensus-based framework for transitional care in IBD that provides a guidance for clinical practice.

Progress in medicine has been made in the past primarily through the clinical experience of physicians and uncontrolled observations. With the advent of medical journals, knowledge dissemination and much of medical progress had been made possible through clinical reports and meticulous observations on cases or series of cases. This was true for many medical breakthroughs, including the initial paper by Burrill Crohn, Leon Ginzburg and Gordon Oppenheimer, who described their observations of a mere 14 surgical patients with ‘regional ileitis’, which later became known as Crohn’s disease.1 However in recent decades, the controlled clinical trial gained primacy as the holy grail of evidence-based medicine, and observational studies similarly became subject to stricter and preferably comparative statistical methodology in the forms of population-based studies, prospective cohorts or retrospective case-control studies. This trend, towards comparative and preferably controlled research methodology as the prevailing dogma, has led to case reports falling out of favour with the medical scientific community touting its potential caveats of chance associations and susceptibility to many uncontrolled confounders. Coupled with the fact that case reports may create less citation potential, which is necessary for a journal impact factor and citation index standing, case reports and case series have also found it increasingly difficult to be published.2 Indeed most leading gastroenterology journals, JCC included, now generally refrain from publishing case reports or small case series.

Although the current doctrine of IBD pathogenesis proposes an interaction between environmental factors and gut microbiota in genetically susceptible individuals, dietary exposures have attracted recent interest and are, at least in part, likely to explain the rapid rise in disease incidence and prevalence. The D-ECCO working group along with other ECCO experts with expertise in nutrition, microbiology, physiology, and medicine reviewed the evidence investigating the role of diet and nutritional therapy in the onset, perpetuation, and management of IBD. A narrative topical review is presented where evidence pertinent to the topic is summarised collectively under three main thematic domains: i] the role of diet as an environmental factor in IBD aetiology; ii] the role of diet as induction and maintenance therapy in IBD; and iii] assessment of nutritional status and supportive nutritional therapy in IBD. A summary of research gaps for each of these thematic domains is proposed, which is anticipated to be agenda-setting for future research in the area of diet and nutrition in IBD.

This paper is the first in a series of two publications relating to the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn’s disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn’s disease. Surgical management as well as special situations including management of perianal Crohn’s disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice for most patients with ulcerative colitis (UC) requiring colectomy.1 Pouchitis is a non-specific inflammation of the ileal reservoir and the most common complication of IPAA in patients with UC.2–7 Its frequency is related to the duration of follow up, occurring in up to 50% of patients 10 years after IPAA in large series from major referral centres.1–9 The cumulative incidence of pouchitis in patients with an IPAA for familial adenomatous polyposis is much lower, ranging from 0 to 10%.10–12 Reasons for the higher frequency of pouchitis in UC remain unknown. Whether pouchitis more commonly develops within the first years after IPAA or whether the risk continues to increase with longer follow up remains undefined.

This ECCO topical review of the European Crohn’s and Colitis Organisation [ECCO] focused on
prediction, diagnosis, and management of fibrostenosing Crohn’s disease [CD]. The objective was
to achieve evidence-supported, expert consensus that provides guidance for clinical practice

The European Union offers opportunities for high-level of funding of collaborative European research. Calls are regularly published: after the end of the FP7 funding programme the new round of Horizon 2020 calls started in 2015. Several topics are relevant to inflammatory bowel disease (IBD) challenges, including chronic disease management, biomarker discovery and new treatments developments. The aim of this Viewpoint article is to describe the new Horizon 2020 instrument and the project submission procedures, and to highlight these through the description of tips and tricks, taking advantage of four examples of successful projects in the field of IBD: the SADEL, IBD-BIOM, IBD Character and BIOCYCLE projects.

The fifth scientific workshop of the European Crohn’s and Colitis Organization (ECCO) focused on the relevance of fistulas to the disease course of patients with Crohn’s disease (CD). The objectives were to reach a better understanding of the pathophysiological mechanisms underlying the formation of CD fistulas; to identify future topics in fistula research that could provide insights into pathogenesis; to develop novel therapeutic approaches; and to review current therapeutic strategies (with clarification of existing approaches to prevention, diagnosis and treatment). The results of the workshop are presented in two separate manuscripts. This manuscript describes current state-of-the-art knowledge about fistula pathogenesis, including the roles of epithelial-to-mesenchymal transition and cytokine matrix remodelling enzymes, and highlights the common association between fistulas and stenosis in CD. The review also considers the possible roles that genetic predisposition and intestinal microbiota play in fistula development. Finally, it proposes future directions and needs for fistula research that might substantially increase our understanding of this complex condition and help unravel novel therapeutic strategies and specific targets for treatment. Overall, it aims to highlight unanswered questions in fistula research and to provide a framework for future research work.

Background and Aims: Perianal fistulas affect up to one-third of Crohn’s patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohn’s and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn’s disease [CD].

Methods: The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn’s disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed.

Results: Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD.

Conclusions:The treatment of perianal fistulising Crohn’s disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohn’s perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.