Crohn’s disease is a chronic progressive inflammatory disease of the gastro-intestinal tract that may lead to bowel damage and disability. Half of patients will require surgery within ten years of diagnosis. Unfortunately, surgery is not curative, endoscopic recurrence is reported in 80% of patients within one year of diagnosis, and predicts clinical and surgical recurrence. The prevention of post-surgical recurrence is a critical target in the care of Crohn’s disease after surgery. Currently, postsurgical management and treatment of Crohn’s disease are based on endoscopic monitoring performed during the first year after surgery. However, colonoscopy is an invasive and expensive procedure, unpleasant to patients. Bowel ultrasound is a cheap, non-invasive, readily-available tool for the assessment and the monitoring of patients with inflammatory bowel disease, especially patients with Crohn’s disease. This presentation aims to review the evidence for the use of bowel ultrasound in the specific setting of postsurgical recurrence in Crohn’s disease; the diagnostic accuracy of bowel ultrasound in the detection of postsurgical recurrence in alternative to colonoscopy; its predictive value for clinical and surgical recurrence.

Clinical cases with contrast-enhanced ultrasound and elastography in Crohn's Disease strictures

Compared to the general population, patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer. Chronic inflammation is believed to promote the development of neoplasia. Adenocarcinoma complicating UC and CD develops from a precursor lesion, dysplasia. Dysplasia complicating IBD is very variable macroscopically and histologically and is often multifocal. Besides conventional dysplasia in patients with IBD, nonconventional dysplasia are described. Three recent publications allow us to better define these new nonconventional types of dysplasia, from a clinical, morphological and molecular point of view, as well as nonconventional mucosal lesions in patients with IBD. Crohn’s disease (CD) is associated with an increased risk of small bowel adenocarcinoma (SBA). Research papers dedicated to small bowel adenocarcinoma (SBA) in patients with Crohn’s disease (CD) are scarce. (Yet, several advances have been accomplished in epidemiology, natural history and characteristics of SBA, in patients with CD). Several recent publications help us to better understand this entity.

Educational Objectives:
1. To review the type of transducers used in intestinal ultrasound (IUS).
2. To review probe orientation and scan planes in IUS.
3. To have an overview of the normal bowel wall in ultrasound and possible mural and extramural findings.
4. To review how to distinguish between small bowel and colon.
5. To emphasise the anatomical landmarks to search for in IUS.
6. To review intestinal ultrasound technique and how to look for each bowel segment.

The talk will show important ultrasound differential diagnosis in IBD 

Educational objectives:
To understand what´s new on the use of IUS in CD regarding the following aspects:
- outcome studies
- activity and fibrosis score
- perineal ultrasound

Educational Objectives:
1. To review the settings in ulcerative colitis (UC) where intestinal ultrasound (IUS) can be used.
2. To review the role of IUS in the management of patients suspected to have UC.
3. To emphasise the important role of IUS as a tool to assess disease activity, severity and extension in UC.
4. To emphasise the important role of IUS as a monitoring tool to assess response to therapy in UC.
5. To have an overview of the existing IUS scores in UC and their applicability.
6. To review potential complications in UC and the role of IUS in predicting surgery.
7. To have an overview of the burning and open questions regarding IUS in UC in 2021.

Educational objectives:
1. Learn about the mechanisms of action of JAK inhibitors such as tofacitinib 
2. Understand the clinical and endoscopic efficacy of tofacitinib in UC and more selective JAKs
3. Discuss the safety profile of tofacitinib and newer JAK inhibitors

1. To understand different treatment options for perianal fistulas beyond TNF-antibodies
2. To have an overview over optimal treatment strategies in patients with perianal fistulas

1. To understand the chronicity of IBD and the need for continuous remission of symptoms
2. To review the drugs available to treat IBD, their indications, their limitations, their optimal use and their potential adverse reactions
3. To emphasise the concept of two goals of therapy which are the achievement of remission (induction therapy) and the prevention of disease flares (maintenance therapy)
4. To have an overview on the new drugs under development

Numerous small molecules and biologics are being tested in phase 1-3 trials. Regarding JAK inihibitors, we still do not know whether JAK selectivity is associated with an improved risk-benefit profile, especially regading zoster risk. TYK2, gut selective or not, look promising and also showed very encouraging results in psoriasis.  Other small molecules targeting integrins or PDE4 may be approbed in a near future. Regarding biologics and beyond biosimilars, many compounds are being developed such as Abivax. One question remains after 2 decades of biologics development : who will beat infliximab? Combination of biologics and bispecific antibodies might tackle this issue. Pending these molecules, many head to head trials are ongoing.

Educational objectives:
1. To understand the mechanism of action of Methotrexate
2. To review its efficacy and appropriate use (mono-, combitherapy)
3. To learn the appropriate management of Methotrexate and its potential adverse events in daily practice
4. To have an overview on other alternative indications

Educational objectives:
1. To provide an overview of different models of IBD.
2. To discuss the choice and appropriateness of different IBD models for different research questions.

To understand the effect of various groups of IBD medications on histology and review the evidence of histological healing 
To review some practical points in relation to microscopic assessment of post surgical changes in diverted rectum & ileo-anal pouch histology

Educational Objectives:

1. Reminder: why nutrition in IBD?
2. How to best deliver nutritional care in IBD: MDT
3. Seeing this through the lens of an adult IBD dietitian
4. Lessons learned from treating adults/elderly with IBD
5. Psychological challenged with nutritional therapy
6. MDT from both our points of view
7. D-ECCO – who we are and what’s in it for you?
    

Summary:

As PIBD specialists we are all aware of the importance and potential of nutritional therapy in IBD, but how is this best delivered?

This presentation, by a dietitian and physician, who are members of the Dietitians of ECCO (D-ECCO) committee, will include our views and experience with managing nutrition in IBD, through a multidisciplinary team. We will mention how to advocate and setup a successful team and highlight some specific settings where an MDT is especially critical, such as peri-surgical care. Lessons learned from treating the elderly IBD population, and the interesting parallels to paediatrics, will be discussed. Finally, we will explain why and how you should get your team involved in D-ECCO activities.

Patients with Inflammatory Bowel Disease (IBD) often experience the problematic and burdensome symptom of fatigue, both during periods of relapse and remission. The optimal management of fatigue in IBD is uncertain, however there is evidence suggesting that physical activity is likely to be a beneficial way of managing the symptom. The aim of this study is to explore the relationship between fatigue and objective measurements of both physical activity metrics and varying intensities of physical activity for individuals with IBD.

A multi-centred, European, cross-sectional, correlational study was employed. A consecutive sample of 187 patients with Crohn’s disease (59%) or ulcerative colitis (41%) were recruited from six IBD centres in the Republic of Ireland (42%), United Kingdom (40%) and Denmark (18%). Fatigue was measured using the IBD-Fatigue (IBD-F) scale, including both the level of fatigue (IBD-F, Section 1) and impact of fatigue (IBD-F, Section 2). Physical activity was objectively measured using scientifically validated triaxial accelerometers (ActiGraph wGT3X-BT) during seven consecutive days.

A moderate level of fatigue (IBD-F Section 1 Md (IQR) = 10 (6 – 13)), predominantly intermittent in nature (72%) was reported by participants (57.4% female; 59% Crohn’s disease; 43% active disease). Participants self-reported sleeping an average of 8.7 hours over the seven nights. During the week, the intensity of activity was predominantly sedentary (Md 5 days, 22 hours, 20 minutes) or light (Md 19 hours, 35 minutes). The median moderate-to-vigorous intensity of physical activity per day was 32.2 minutes and step count over the week was 47052 steps. There was no evidence of a unique linear or non-linear relationship between each of the objective measurements of physical activity with IBD-related fatigue. This lack of evidence extended separately to patients in remission and to patients with active disease. These findings are in the context of a statistically significant moderately-strong relationship between disease activity (measured using both HBI and SCCAI) and level of fatigue for both patients of Crohn’s disease (r_s = .327, p = .001, n = 96) and ulcerative colitis (r_s = .353, p = .003, n = 71).

This large multi-centred study shows no association between objective measurements of physical activity and IBD-fatigue. These findings suggest that engaging or not engaging in physical activity has no differential impact on self-assessment of fatigue.