You have been honoured with one of the United European Gastroenterology’s (UEG) Lifetime Achievement Awards in recognition of your contributions to gastroenterology. Looking back across your career, what do you consider your greatest achievement, and which developments in inflammatory bowel disease (IBD) have most transformed the way we understand and treat the condition?
I have been working in this area for more than 30 years. I started initially with basic science, looking at healing of the intestinal epithelium. Later I moved also to clinical studies to translate findings from basic research into clinical practice.
I did a lot of studies initially in the field of mesalazine, which is still a standard of care for mild to moderate ulcerative colitis. I investigated the release patterns of different mesalazine formulations, but also their clinical aspects. I was one of the first to introduce the calcineurin inhibitor tacrolimus in patients with very severe ulcerative colitis.
But I think my major achievement, looking at the global community and patients, is my long-term involvement in clinical practice guidelines. I started working on guidelines 30 years ago, even as a fellow, and relatively soon became responsible for coordinating them. I did this in Germany for more than 20 years, then transferred my knowledge internationally.
I developed the guideline programme of the European Crohn’s and Colitis Organisation (ECCO). I was the first Guideline Committee chair, so I developed the first White Book for guidelines and the full guideline programme. We started with Crohn’s disease and ulcerative colitis, but developed a comprehensive programme, including guidelines for diagnostic management, pregnancy and IBD, opportunistic infections, and extra-intestinal manifestations of IBD.
When I moved on to UEG, I became the founding chair of the Quality of Care Committee, which evolved from the guideline task force into one of UEG’s main pillars. I broadened the scope to create a repository of guidelines covering the full field of gastroenterology.
Many of us are highly specialised. Hepatologists may not know that much about IBD, for instance and vice versa. In many countries, gastroenterologists have to take care of IBD, hepatology, and endoscopy, so having a repository where you can find all the guidelines from the various specialist member societies is extremely useful.
Overall, I think this is the achievement that has made the greatest impact on European and global gastroenterology.
You served as UEG President during the COVID-19 pandemic, when traditional conferences and face-to-face collaboration were severely disrupted. How did you navigate this unprecedented period of leadership, and what lessons did the experience teach you about leading a major scientific organisation through a crisis?
I always call myself the virtual president, because I was vice president for 2 years, learning how to become president, and everything was supposed to happen on site. After about 3 months of my presidency, it was clear that we could not continue as planned.
I was lucky to work with the terrific team at UEG and its headquarters. We decided very early on that we would not hold our congress, which was supposed to take place in October, 6 months later. We had already spent a considerable amount of money, and there was no insurance for this type of situation, but we stopped the work and rapidly switched to an online setting.
This helped us a lot, but other societies struggled. If events were cancelled and there was no virtual alternative, there was no meeting at all. Virtual meetings were still a rare experience, and many colleagues were not familiar with how to hold them.
We had a staff of around 50 people, and we are financed through congresses and sponsorship. It was difficult even having to consider layoffs, but it was so important to us to keep everyone. We told them they needed to develop expertise in virtual meetings, and the whole team was dedicated to making this work.
Our first meeting took place in the midst of another COVID lockdown. Only people from Germany and Austria could travel to Austria, where the meeting was planned, while everyone else participated virtually. We were very lucky to have industry support, and our sponsors were willing to make new arrangements for a virtual meeting.
It was a very, very difficult time, but we were the first society to deliver such a successful congress. I think we had around 8,000 participants. We could also use our platform to educate people about COVID.
UEG is a very complex organisation, with more than 50 national member societies and 17 specialist member societies. There is a large council, an executive committee, and a lot of democracy. Convincing people to cancel a congress required considerable discussion and preparation.
We were used to making decisions face-to-face, and suddenly everything was virtual. It was a learning experience in how to manage, collaborate, and maintain the networking that is so important to us.
Beyond research and clinical practice, you have made significant contributions to medical education, including through the IBD Essentials podcast and the myUEG Associate Programme. Why is accessible, continuous medical education so important today, and how do you see digital platforms shaping the future of gastroenterology training?
This is extremely important, and one of my major goals is to educate not only younger people, but also colleagues globally.
I personally feel we are very lucky to live in Europe, but even here, there are places where there is not enough funding for education.
UEG is the best educational resource you can have in Europe if you are a gastroenterologist, because it covers the whole field, from nutrition to oncology and endoscopy. Everything comes together, providing a unique basis for education.
However, if you are not funded, you cannot attend meetings. In hospitals and clinical practice, but also for scientists, everything is getting tougher, and you may not be allowed to be away from work for more than 2 days, or sometimes at all. With modern technology, making recordings and making them accessible online is much easier. This was something we achieved, and it was very important to me.
We created the myUEG Associate Programme to get in touch with people. We knew there were around 50,000–60,000 people interested in digestive health in Europe, but we could not use their email addresses or other information. Through the programme, we have now reached more than 40,000 people over the past 4 years. It has been extremely successful. We now also have the Gutflix programme, which offers many learning opportunities.
I believe it is a major advantage for people to see the full breadth of gastroenterology. Not everyone needs to become a hepatologist, endoscopist, or IBD specialist. There is something for everyone. If you are a more community-based gastroenterologist, you can see the full breadth of the field and decide where your interests lie. This is what I enjoy about UEG meetings: you have everything in one place and can keep up to date with the wider field of gastroenterology.
As you look ahead to the next 5–10 years, what do you believe will be the most important developments in IBD management, and where do you see the greatest opportunities to improve long-term outcomes and quality of life for patients?
This is a very complex question for someone who has been working in the field for more than 30 years. We are now in a very lucky situation. We have lots of new treatment options ahead. When I started, we had steroids, mesalazine, and thiopurines. Now we have a whole range of treatment options, as well as much better tools to diagnose and monitor patients.
It is important to put these into the right perspective: what should be done first, second, and third? We are still lagging behind oncology because one of our major problems is that we do not have predictive markers for the disease course or response to treatment. It is still more like trial and error.
I expect a lot of things to change in the next 10 years. With the new possibilities offered by AI, we will be able to improve patient care and outcomes. It will become much easier to assess huge amounts of data and improve our diagnostic approach. Endoscopy is still a manual and visual learning process, but AI can make things much easier and help educate people.
Ultimately, what I believe is very important is that we have moved from symptom-based treatment approaches towards more objective and patient-centred approaches. This has now become the standard of care in IBD. We are no longer happy simply to have clinical symptoms in remission. We look for biomarker remission and are improving the biomarkers we use. We know that mucosal healing is important, and we are now investigating the depth of it.
For most of us, the patient is the focus. If you look at the WHO’s concept of health, it is not only about having no symptoms, but also about having a normal quality of life.
My typical example is a patient treated with steroids. The clinical symptoms may completely resolve, but the patient can experience numerous side effects: sleep disturbances, acne, hypertension, etc. This is not quality of life. We need a more comprehensive and holistic view of our patients, and this has become part of our thinking.
Finally, for the first time, we may be able to address things that we could not really address in the past. Several trials suggest that we may have antifibrotic agents that could even reverse something previously believed to be irreversible. If a patient with Crohn’s disease has a fibrotic stricture, the only option has traditionally been surgery to remove it. With new agents on the horizon, we may even be able to reverse some of these strictures without surgery. This is something I am really looking forward to.
Finally, having played such an important role in UEG’s development, from guideline leadership to the presidency, how does it feel to see the organisation’s continued growth and impact today, and what legacy would you most like to leave for the next generation of clinicians and researchers?
For me, it is really lovely to see how the organisation is growing and developing. One of my aims was always to have UEGW as the biggest gastrointestinal meeting in the world.
During the pandemic, we had the biggest virtual congress, but not the biggest in-person congress. Here in Barcelona, at UEG Week, we have over 14,200 participants. I believe UEG Week has become the biggest gastrointestinal-related congress in the world.
We are constantly changing formats and introducing new ideas. What I believe is very important is that we aim to be diverse and include everyone, including the very young. Compared to when UEG started, I feel that we’ve really improved on that front. We cover everyone, and I think this is extremely well received by the community.
As for the legacy I would like to leave, what I always recommend to my own residents and fellows is that they should be curious. They should not follow pre-defined pathways; they should ask questions and develop their own path.
If you have a different opinion, try to defend it and fight for it. Sometimes younger colleagues do not dare to challenge a senior, so I deliberately try to provoke them into questioning my decisions.
One of my favourite stories is about a third-year fellow who challenged my proposed approach to treatment for a patient with very severe ulcerative colitis. I reflected on her concerns, explained my reasoning, and 2 days later she acknowledged that I had been right.
A lot of people in my position might not be happy with this, but I liked it a lot. It keeps you thinking, because sometimes you rely on what you learned in medical school or what you know instinctively, without necessarily questioning the reasoning behind it.
This is what I want younger colleagues to do: create their own pathway, their own research direction, and their own educational path. When they finish their training, they should be independent and able to step up to the next position, whether that means becoming a hospital chair or going into private practice, and treat patients confidently.
