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Chapter 3. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition in Recent Years

Koletzko, Berthold; Shamir, Raanan; Broekaert, Ilse; Troncone, Riccardo§

Author Information
Journal of Pediatric Gastroenterology and Nutrition: April 2018 - Volume 66 - Issue - p S29-S43
doi: 10.1097/MPG.0000000000001913

Abstract

The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) started as a group of 36 friends who held an informal meeting with some 20 oral presentations to share what they were working on in the clinic and in the laboratory, and it grew to a now extremely strong, highly professional and globally impactful organisation dedicated to research and clinical care related to gut, liver, and nutritional health of infants, children, and adolescents. We are both happy and proud that ESPGHAN is in a very healthy situation, stronger, and more active now than ever before in the 5 decades since its foundation. ESPGHAN hosts the largest congress in the field worldwide, with attendance of more than 4500 delegates from all 5 continents. ESPGHAN also maintains an exuberant level of activity throughout the year through its Committees, Special Interest and Working Groups and associated research networks that support international research collaborations, guidance for clinical care, and state-of-the-art education, often with marked international impact on clinical practice and standards in Europe and worldwide. The basis of the success of ESPGHAN is the enthusiasm and engagement of its membership that donates extensive volunteer work and outstanding contributions to the Society and to supporting child health, while maintaining a positive spirit of collaboration and friendship so characteristic of ESPGHAN.

FIGURE 1
FIGURE 1:
Berthold Koletzko.

ESPGHAN TODAY

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition is a multiprofessional nonprofit organisation seated in Geneva, Switzerland. ESPGHAN's mission is to promote the health of children with special attention to the gastrointestinal tract, liver, and nutritional status, through knowledge creation, the dissemination of science-based information, the promotion of best practice in the delivery of care and the provision of high-quality education for paediatric gastroenterology, haepatology, and nutrition professionals in Europe and beyond. The constitution and an operational guide, the ESPGHAN Rules and Regulations document, are available on the website of the association, at www.espghan.org. ESPGHAN provides representation for all professionals involved in Paediatric Gastroenterology, Hepatology and Nutrition (PGHAN), promotes basic, translational, and clinical research; lobbies for stronger support of research and high standards of care; and offers the highest standards of education to members and all professionals involved in PGHAN. ESPGHAN dedicates particular attention to new investigators and trainees to ensure they are supported and encouraged. ESPGHAN also aims to serve as a source of competent advice for governments, international agencies, and relevant stakeholders.

The Annual General Meeting of full ESPGHAN members is the ultimate decision-making body that elects the President, General Secretary and Executive Treasurer (who together form the Executive Committee), 6 additional council members, and the chair of the Local Organizing Committee of the annual congress (Fig. 2). Table 1 presents a list of the Presidents, Secretaries, and Treasurers of ESPGHAN. The chairs of the Young ESPGHAN Committee and of the Allied Health Professionals Committee, and the President Elect or Past President (for 1 year each) also attend the council meetings. Additional volunteers serve as the Editor of the Society's journal, The Journal of Pediatric Gastroenterology and Nutrition, the website editor, the e-learning editor, chairs of further committees, Special Interest Groups and Working Groups, and others.

FIGURE 2
FIGURE 2:
Organisational structure of ESPGHAN.
TABLE 1
TABLE 1:
List of ESPGHAN presidents, secretaries, and treasurers

ESPGHAN has 3 main standing committees focusing on PGHAN (Fig. 2). They aim at promoting child health and increasing the understanding and treatment of disease states. ESPGHAN members are also involved in a large number of currently ≈30 Special Interest Groups and Working Groups that focus on particular aspects of child care and/or disease states, for example, celiac disease, inflammatory bowel disease, endoscopy, liver transplantation, clinical malnutrition, and early nutrition research, to name just a few (Table 2). The Allied Health Professional Committee aims to enhance the multidisciplinary approach towards PGHAN in Europe. The Young ESPGHAN Committee promotes and supports specialist training and guides trainee members, within the first 5 years after entering subspecialty training, towards full membership of ESPGHAN. ESPGHAN promotes scientific exchange among research groups in Europe and among trainees, young doctors, and scientists through PGHN Schools, Young Investigator Forums, Monothematic Meetings, Master Classes, International Schools, and Eastern European Schools.

TABLE 2
TABLE 2:
ESPGHAN Working Groups and Special Interest Groups 2017

THE ESPGHAN MEMBERSHIP

ESPGHAN is an association of members; the members are the Society. While membership was initially restricted to established academic leaders in the field, over the years the Society has become more and more inclusive. After the recent change of membership criteria, adopted in 2013, membership is now open to all health care professionals dedicated to PGHAN. Consequently, the number of members has been steadily increasing to now more than 800 active and fully paid members (Fig. 3), with an increasing proportion of young members and allied health care professionals such as nurses, dieticians, psychologists and others (Fig. 4). It is particularly encouraging to see a rising proportion of young colleagues joining ESPGHAN (Fig. 5). Women comprise 40% of the members, with a particularly high proportion among younger members. While most members are from Europe, the membership has become truly global, currently representing 72 different countries (Fig. 6).

FIGURE 3
FIGURE 3:
Growth of the ESPGHAN membership.
FIGURE 4
FIGURE 4:
Members per category 2017.
FIGURE 5
FIGURE 5:
Age distribution of ESPGHAN members 2017.
FIGURE 6
FIGURE 6:
Geographical distribution of ESPGHAN members 2017.

DIGITAL INFORMATION SHARING

With the increasing and global membership, digital sharing and exchange of information has become an important priority to serve the needs of members. Therefore in 2015 we launched a new and markedly improve website (Fig. 7) after investing 2 years of intensive work of the president, treasurer, website editor and council. We are proud of an intuitive and easy to navigate website with modern web design and much enhanced functional capabilities. Social media share buttons are integrated. The “MyESPGHAN”—section offers personalized pages and additional information for members. Since 2017, members can also post questionnaires and job posting on our website. It is encouraging to note great acceptance and high usage of our improved website. We also introduced in 2014 a new, interactive electronic newsletter, which is sent out monthly to all members and provides regular updates on news, current developments and opportunities, and upcoming events.

FIGURE 7
FIGURE 7:
Snapshot from the ESPGHAN website 2017.

STANDARDS OF PRACTICE: THE ESPGHAN CODE OF CONDUCT

ESPGHAN is dedicated to excellence and integrity in scientific and medical clinical practice aiming at generating and consolidating trust at all levels. Therefore, we started an initiative to develop a comprehensive document to address these important issues, which ESPGHAN adopted in 2015 as its “Code of Conduct” (see Supplementary Material 1, Supplemental Digital Content 1, http://links.lww.com/MPG/B282). The document summarizes the ethical foundations of ESPGHAN's obligation to ensure that paediatricians and allied health care professionals acquire and maintain knowledge, skills, and values that are central to paediatrics and child health without undue bias due to financial or commercial interests. The ESPGHAN Code of Conduct analyses the ethical challenges that can be posed when ESPGHAN members who organize, teach, or serve other roles in medical education have financial relationships with companies that have a direct interest in recommendations. It also illustrates strategies for mitigating the potential of such financial relationships to influence professional education in undesired ways. ESPGHAN's Code of Conduct also governs the relationship between ESPGHAN and industry representatives involved in the support of research and educational activities in the field of PGHAN. Besides identifying the principles of transparency, independence and accountability, the Code of Conduct provides a practical approach to how to maintain the independence and integrity of ESPGHAN's related professional education while promoting a trustworthy relationship between ESPGHAN and commercial companies. We are conscious that the ethical conduct of our association must go beyond the sole development and adoption of this Code of Conduct, but that we also need to foster a culture of integrity, responsibility, transparency, and critical open discussion in our organisation, focussing on the interest of our patients and their families.

THE ANNUAL CONGRESS OF ESPGHAN

The ESPGHAN annual congress (Fig. 8A–F) is the largest meeting in PGHAN in the world, with an attendance in 2017 that exceeded 4500 delegates from almost 100 countries on all 5 continents. The congress offers an excellent platform for members and nonmembers to exchange new research findings in the different fields of our specialty, to hear updates on the state of the art in research, clinical practice, and policy, and to meet key opinion leaders and colleagues from all over the world. It also gives ESPGHAN members opportunities for working group meetings and postgraduate courses. The number of abstracts submitted has been steadily increasing and has now reached close to 1000 abstracts per year. To serve the interest of the large number of clinical practitioners attending the meeting, in 2014 we introduced a new Clinical Practice Track and in 2015 a new hands-on learning zone in endoscopy, which have all been highly appreciated and successful. The use of digital tools is continuously expanded, with an interactive congress app for handheld devices, ePosters, a Virtual Meeting Site, and a Website on Demand, which enhance information sharing and convenience for delegates, for example, by accessing handouts and webcasts of presentations. Since 2015 our annual congress is joined by a variety of patient and parent organisations at the congress with whom we wish to closely collaborate to achieve our goal to optimally support patients and their families. Our members can enjoy the added privileges of the ESPGHAN Members Lounge to meet or enjoy a quiet moment, and the newly introduced Young ESPGHAN Lounge. The annual Members Dinner at the congress provides a unique opportunity for meeting friends and colleagues in a relaxed atmosphere, and to enjoy a programme of great fun.

FIGURE 8
FIGURE 8:
A, 48th ESPGHAN Congress 2015, Amsterdam. B, Prof Marc Benninga at the opening cabaret, 48th ESPGHAN Congress 2015, Amsterdam. C, Prof Bert Koletzko at the reception for Patient and Parent Organisations, ESPGHAN Congress. D, Prof Luigi Dall’Oglio (far right) teaching at the Endoscopy Learning Zone, ESPGHAN Congress. E, The abstract presentations of new results through posters, e-posters, and oral presentations are the core of ESPGHAN congresses and always draw a lot of attention. F, Prof Raanan Shamir presenting the ESPGHAN Distinguished Service Award 2017 to Prof Olivier Goulet.

COMMITTEES, SPECIAL INTEREST GROUPS, AND WORKING GROUPS

ESPGHAN's main Committees on Gastroenterology, Hepatology and Nutrition, and the many other Committees (Table 3) and Special Interest and Working Groups (Table 2) engage in numerous activities throughout each year, such as developing recommendations and clinical guidelines on pertinent topics in the field, facilitation, and execution of collaborative research studies, and engagement in educational and training activities. Many ESPGHAN guidelines have set global standards for practice, clinical care, policy and regulatory decisions not only in Europe but throughout the world and are highly cited, for example, 799 citations of the guideline for the diagnosis of coeliac disease 2012 (1), 408 citations of the ESPGHAN Comment on Complementary Feeding 2008 (2), 372 citations of the guideline on enteral nutrient supply for premature infants (3), 285 citations of the comment on dietary products for infants treatment and prevention of food allergy (4), 229 citations of the global standard for infant formula composition (5), and 204 citations of the comment on breastfeeding (Web of Science, October 26, 2017).

TABLE 3
TABLE 3:
ESPGHAN Committees 2018

With the increasing role of ESPGHAN in influencing research and clinical practice, the need to discuss issues of importance to child health, conditions of clinical care, and research with political decision makers particularly at the European level has become more pressing. Therefore, in 2013 we created the new Public Affairs Committee to raise awareness for themes related to paediatric digestive health, with a particular focus on the European Commission and European Parliament where repeated meetings and events were held to lobby for greater support for child health and related research (Fig. 9). The Public Affairs Committee also engages in interaction with international agencies such as the World Health Organisation, the European Medicines Agency (6), and the Codex Alimentarius where ESPGHAN has been accepted as a registered observer organisation in 2003 and ever since has proactively contributed to the development of standards for dietetic food products for infants and young children (5,7). The Public Affairs Committee coordinates the close collaboration of ESPGHAN with patient and parent associations related to paediatric digestive health, which is considered to be a key strategic priority.

FIGURE 9
FIGURE 9:
The ESPGHAN Public Affairs Committee meets with members of the European Parliament and representatives of the European Commission in the European Parliament building to discuss the need for stronger research funding in the area of paediatric gastroenterology, hepatology, and nutrition.

The History Committee was newly formed in 2014 with the goals to compile the history of PGHN and of ESPGHAN, and to build an ESPGHAN archive with records of the foundation of the Society, annual meetings, and other activities. This very publication on the occasion of the 50th anniversary of ESPGHAN is a result of the successful work of this Committee.

YOUNG ESPGHAN

The Trainee Committee was formed in November 2009 during the United European Gastroenterology (UEG) Congress in London with the vision to involve and support trainees in PGHAN within ESPGHAN. One of the first meeting reports concludes: “The ESPGHAN Trainee committee is currently surveying the trainees to identify how training is carried out in the member countries. From this we may be able to ascertain areas of training which need targeting, this may include practical procedures and log books, theoretic knowledge, mentoring or the identification of training leads.” The Society encouraged the Young ESPGHAN Committee to expand the group and facilitated the involvement of Trainee Members with ESPGHAN, for example, by becoming members of the other standing committees. In 2015, the name of the Committee was changed to “The Young ESPGHAN Committee: Committee for Trainees and Young Investigators” to indicate that all young members within the first 5 years after joining the society should be represented, including nonclinical scientists and early career clinicians who already finished their training. Today young ESPGHAN members comprise the fastest growing membership category within ESPGHAN. The Young ESPGHAN Committee meets face-to-face twice yearly and reaches out to its members via e-mail, LinkedIn, and Twitter, with the last one being very popular during the annual conferences. It channels its members’ concerns via surveys and round table discussions at the annual conferences. Furthermore, the committee is actively involved with e-learning, ESPGHAN summer schools, and endoscopy/motility learning zones at the annual conferences and promotes these activities to its membership. During the annual conference, Young ESPGHAN has held its own workshop on career development skills, and during the last members’ dinners the committee attracted ESPGHAN members by rewarding the “best behaving” monkey group and the “cleverest pilot”! In 2016, a group of 5 Young ESPGHAN members received the FISPGHAN expert team award at the WCPGHAN in Montreal, Canada, and produced a very instructive teaching video on treatment of acute gastroenteritis, which is now available at www.fispghan.org. The Young ESPGHAN committee has reached out to the Young NASPGHAN Committee, Young Talent Group UEG and Young ECCO. In 2017, the society and Young ESPGHAN have started a mentoring program for its new Young members. Young ESPGHAN is also working on optimizing transition from Young to Full ESPGHAN membership. The Young ESPGHAN thanks for tremendous support it has received from the ESPGHAN Presidents Deirdre Kelly, Riccardo Troncone, Berthold Koletzko, and Raanan Shamir.

Over the years, Young ESPGHAN has established itself with an important role within ESPGHAN, and its activities have been very well received and greatly appreciated. The ongoing enthusiasm and engagement of Young ESPGHAN in the ESPGHAN activities and the support from the ESPGHAN members and its Council provide an excellent basis for a bright future of ESPGHAN!

RESEARCH NETWORKS AND COLLABORATIONS ARISING OUT OF ESPGHAN

One of the core goals of ESPGHAN is to promote basic, translational, and clinical science in our field, and to enhance financial and other means of support for research, including collaborative and multidisciplinary research. Research priorities have recently been defined (8). The strong and active networks of leading experts in different areas of PGHAN provides excellent opportunities for scientific collaboration and successful multicentric research grant applications. This should be illustrated by the following recent examples of success of funded research consortia that have arisen out of ESPGHAN collaborations. The Paediatric European Digestive Diseases Clinical Research Network (http://www.espghan.org/about-espghan/research/paediatric-european-digestive-diseases-clinical-research-network-peddcren/) coordinated by Nick Croft was established in 2013 with financial support from UEG to form a network of clinical trials for studying and ultimately providing effective medicines for infants, children, and adolescents with disorders in the area of PGHAN. The European Network Study on Malnutrition and Outcome in Hospitalized Children in Europe coordinated by Berthold Koletzko received a network grant from the European Society for Clinical Nutrition and Metabolism (www.espen.org) and was established with the ESPGHAN working group Clinical Malnutrition to explore the prevalence and effects of undernutrition among more than 2500 hospitalised children in 12 countries, and it also studies opportunities for nutrition screening (9,10). The European Commission (EC) funded “PreventCD” project (http://www.preventcd.com) coordinated by Maria Luisa Mearin studied the natural history of coeliac disease and the effects of infant feeding on disease manifestation (11). The “Early Nutrition Project” coordinated by Berthold Koletzko and also funded by the EC (www.project-earlynutrition.eu) explores long-term effects of early nutrition on later health, with a focus on opportunities for prevention of obesity and associated disorders (12). The EC funded “Paediatric Inflammatory Bowel Disease network for Safety, Efficacy, Treatment and Quality Improvement of Care” (http://cordis.europa.eu/project/rcn/199745_en.html) coordinated by Frank Ruemmele aims to establish a long-term inception cohort of paediatric IBD patients and to perform a randomised clinical therapeutic trial. The EU funded regional project “Focus in CD – Innovative coeliac disease learning model for health care professionals in the Danube region” (http://www.interreg-central.eu/Content.Node/Focus-IN-CD.html) coordinated by Jasmina and Jernej Dolinsek aims at strengthening knowledge and awareness on coeliac disease among health care professionals and the general public. The Erasmus Plus programme in Capacity Building in Higher Education funded the “Early Nutrition eAcademy South East Asia” coordinated by Berthold Koletzko focusses on eLearning in paediatric nutrition for health care professionals in Malaysia, Thailand, and neighbouring countries, in close collaboration with ESPGHAN's eLearning programme. Many more opportunities exist for successful research and education activities based on the strong ESPGHAN network. Following previous successes, in 2018 ESPGHAN provides 3 grants of 50,000 Euros each to support and enable the creation of more successful networks.

EDUCATION

ESPGHAN strives to develop an up-to-date, independent, high-quality educational programme for health professionals that caters to their immediate and changing needs. ESPGHAN seeks to continuously improve its educational programme and to present additional courses and educational materials that cover niches or complement existing training opportunities and products. In addition, ESPGHAN believes it has a responsibility for the education of underprivileged areas outside Europe where the needs for education and training are more urgent, although learning and research priorities may be substantially different. The ESPGHAN training activities are guided by the European Training Syllabus in Paediatric Gastroenterology, Hepatology and Nutrition that was updated in 2014 (13) and defines minimum requirements for training to support recognition as a European Specialist in paediatric gastroenterology, hepatology, and nutrition, along with a logbook on necessary achievements. The Education Task Force, established in 2017, aims to integrate all core activities within a 5-year cycle.

The ESPGHAN Summer Schools for trainees and fellows have become regular events and a huge success story ever since the inception of the first Gastroenterology School in 1990 and the first Nutrition School in 1991. The combination of high-quality training with an informal, communicative atmosphere, and the close interaction of delegates and a small resident faculty creates an unforgettable learning experience for participants, many of whom have become active ESPGHAN members. Since its beginning ESPGHAN has established close links between western, central and eastern Europe and has built bridges and strong links across Europe. After the fall of the boundary dividing former “Western Europe” and the “Warsaw Pact Countries” and the end of the Cold War, these links have been proactively strengthened and dedicated ESPGHAN summer schools were held at least once a year in Central and Eastern Europe. These courses have attracted many highly talented colleagues from this part of the world to join ESPGHAN, a number of which today are among the thought leaders of our society. Training activities have also been organized outside of Europe to support areas with special needs, for example, the ESPGHAN Update Course for colleagues from the middle east countries held in Istanbul, Turkey, in 2014 (Fig. 10), the Training Course for Rising Stars from Latin America hosted by LASPGHAN in Cancun, Mexico, in 2014 in collaboration with ESPGHAN and NASPGHAN, or the International Paediatric Nutrition School in Thailand in 2016 organized jointly by ESPGHAN and the Society of Paediatric Nutrition of Thailand (Fig. 11). Perhaps the most successful training outside of Europe has been the regular “ESPGHAN goes Africa” diploma course for African colleagues, with two 1-week courses per year held in Cape Town from to 2012 to 2015, in close collaboration with the Universities of Cape Town and of Stellenbosch, South Africa (Fig. 12). About 120 paediatricians from the whole Sub-Saharan African region received intensive training in paediatric gastroenterology, hepatology, and nutrition based on lectures, case presentations with intense discussions, e-learning, visits to local hospitals, and final examinations. ESPGHAN provided financial support to more than 20 of the participating colleagues to attend the reciprocal “Africa goes ESPGHAN” event held at the 49th Annual Congress of ESPGHAN at Athens in 2016.

FIGURE 10
FIGURE 10:
Dr Dan Turner (Jerusalem) presents at an ESPGHAN Update Course for the Middle East in Istanbul in 2013, jointly organised with the Pan Arabian Society for Paediatric Gastroenterology, Hepatology, and Nutrition.
FIGURE 11
FIGURE 11:
Participants of the Paediatric Nutrition course organized jointly by ESPGHAN and the Paediatric Nutrition Society of Thailand in 2016.
FIGURE 12
FIGURE 12:
Participants of a “ESPGHAN goes Africa” Training Course in Cape Town, South Africa, jointly organised by Prof Michael Lentze (first row, 4th from right) and Prof Jan Taminiau from ESPGHAN and Dr Liz Goddard, University of Cape Town (first row, 2nd from right), and Dr Etienne Nel, University of Stellenbosch (first row, 3rd from right).

EDUCATION PARTNER PROGRAMME

To further stabilize and strengthen the numerous regular education activities, we launched in 2015 the ESPGHAN Education Partner Programme that aims at ensuring the on-going development and implementation of an up-to-date, independent, high-quality educational programme for health care professionals. It is designed and implemented in full compliance with current professional and Continuing Medical Education (CME) standards and with our Code of Conduct, to promote confidence in independence, integrity and credibility of ESPGHAN and its industry partners. The key target groups include Trainee Members and other young health care professionals (addressed primarily by the ESPGHAN Summer Schools and the Young Investigator Forum), established specialists (addressed by the new Master Classes introduced in 2015 that are offered exclusively for ESPGHAN members), as well as health care professionals from less privileged areas (Eastern European Summer Schools, International Schools). In 2017, 7 sponsors (www.espghan.org/education/) each donated 50 000 Euro to support the training courses listed in Table 4.

TABLE 4
TABLE 4:
Training activities under the ESPGHAN education partnership programme in 2017

ESPGHAN AWARDS AND GRANTS

ESPGHAN provides numerous grants, awards, and prizes to members and nonmembers, including

  • Annual Research and Networking Grants, EUR 50,000 (3 per year).
  • Charlotte Anderson Travel Award, EUR 3000.
  • ESPGHAN International Exchange, EUR 3000 (7 per year).
  • Young Investigator Awards (YIA) for abstract presenters at the ESPGHAN, UEG and WCPGHAN conferences up to EUR 1000.
  • John Harries, Alex Mowat, and Jean Rey Prizes (best abstract presentations at the ESPGHAN congress in the fields of gastroenterology, hepatology, and nutrition, respectively), EUR 2500.
  • The joint ESPGHAN / NASPGHAN Travel Award, USD/EUR 5,000.

The highest honour of the Society is the ESPGHAN Distinguished Service Award that was inaugurated in 2010 (14). It is presented annually to an individual who has made a major contribution to the development of paediatric gastroenterology, hepatology, or nutrition. The selection criteria include

  • Outstanding scientific achievements related to paediatric gastroenterology and/or hepatology, and/or nutrition, usually documented by the candidate's publication and citation record
  • Outstanding contributions to the standards, practice, and training in the fields of paediatric gastroenterology and/or haepatology and/or nutrition
  • Outstanding contributions to ESPGHAN as a society
  • Personal integrity.

This special honour has been awarded to Profs John Walker-Smith in 2010 (14), Salvatore Auricchio in 2011, Martin Burdelski in 2012, David Branski in 2013 (15), Peter Milla in 2014 (16), Olle Hernell in 2015 (17), Deirdre Kelly in 2016 (18), and Olivier Goulet in 2017 (19).

COLLABORATION WITH OTHER ASSOCIATIONS

ESPGHAN has engaged in partnering with several other associations with joint interests (Table 5). For a number of years, representatives of the national PGHN societies across Europe have met with the ESPGHAN officers at the ESPGHAN Congress to discuss issues of common interest and opportunities for harmonization. To strengthen the collaboration of the national associations across Europe among each other and with ESPGHAN, we formally established the ESPGHAN National Societies Forum in 2015 as a platform for sustained collaboration and joint activities with all Presidents of National PGHAN societies across Europe to act as a bidirectional link between ESPGHAN and the National Societies. As a first project, a joint standard for implementing training in PGHAN is supposed to be developed, based on the ESPGHAN Training Syllabus (13), aiming towards enhanced harmonization and quality assurance of subspecialty training across Europe.

TABLE 5
TABLE 5:
Close partner societies of ESPGHAN

COLLABORATION WITH THE NORTH AMERICAN SOCIETY OF PEDIATRIC GASTROENTEROLOGY

The most long-standing and closest collaboration of ESPGHAN probably is that with its North American sister society, which actually was established after the model of the European society by Jon Vanderhoof after he participated in the ESPGAN (then still without Hepatology in the name) conference in 1986 in Edinburgh. The close collaboration is facilitated by a number of individuals that are members of both ESPGHAN and NASPGHAN, regular participation of European and North American colleagues, respectively, in the annual congresses on the other side of the Atlantic, a series of successful joint congresses held in 1978 in Paris, 1985 in New York, 1990 in Amsterdam, 1994 in Houston, and 1998 in Toulouse, which laid the ground for the creation of the World Congresses on PGHAN held from 2000 onwards (see below), a large number of joint guidelines and position papers, and not the least joint engagement in the co-owned journal.

THE JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION

A visible manifestation of the close and trusting collaboration of ESPGHAN and NASPGHAN is the Journal of Pediatric Gastroenterology and Nutrition (JPGN; www.jpgn.org). The journal was founded by Dr Emanuel Lebenthal and became the official journal of both societies in 1991. This only journal dedicated to PGHAN today is managed jointly by an ESPGHAN editor (currently Hania Szajewska, Warsaw) and a NASPGHAN editor (currently Mel Heymans, San Francisco). The current (2016) journal Impact Factor is 2.799, after 2.298 in 2011, 2.196 in 2012, 2.873 in 2013, 2.625, in 2014 and 2.400 in 2015. Our Journal is valued as one of the top paediatric subspecialty journals and has established itself as a leading platform for publishing research articles related to PGHAN as well as guidance on clinical practices, such as the guidelines of ESPGHAN and NASPHAN and the working group conclusions of FISPGHAN. JPGN publishes original papers and reviews dealing with all aspects of PGHAN, including normal and abnormal functions of the alimentary tract, the liver, and associated organs. Particular emphasis is devoted to developmental aspects, and to infant and childhood nutrition. JPGN offers fast-track publication available for selected articles of general scientific or public health importance. Accepted original manuscripts are posted as Publish Ahead of Print (PAP) within 3 of 5 days of acceptance and indexed in PubMed within a few days. The full text is available to all ESPGHAN and NASPGHAN members, online and in print, and to numerous institutions worldwide. Articles are open to the public 1 year after publication.

THE CREATION OF FISPGHAN AND THE WORLD CONGRESS SERIES

Building on the success of the combined NASPGHAN-ESPGHAN meetings and the attendance of colleagues from around the world, in 1998 the ESPGHAN president Stefano Guandalini initiated a discussion about expanding these into global World Congresses to address PGHAN issues and colleagues from all parts of the globe. Obviously he was very convincing, since a first World Congress was successfully held in Boston, when also the global Federation of International Societies on Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN; www.fispghan.org) was created by the sisters in the Asian and Pacific region (APPSPGHAN), Europe (ESPGHAN), Latin America (LASPGHAN), and North America (NASPGHAN), with additional associate membership of the Commonwealth Association (CAPGAN) and since 2016 also of the Pan Arabian (PAPGHAN) societies. The Second World Congress in Paris, France in 2004 was co-hosted by Prof Olivier Goulet and ESPGHAN. The next world congress will be jointly hosted by FISGHAN and ESPGHAN in Copenhagen in June 2020. In addition to the World Congresses, FISPGHAN also maintains expert working groups that develop position and guideline papers with global perspectives.

UNITED EUROPEAN GASTROENTEROLOGY

ESPGHAN was 1 of the 7 sister associations that jointly discussed the idea of creating an umbrella organisation to represent all aspects of digestive health in Europe and in 1990 formally created the United European Gastroenterology (UEG). The first UEG congress, then called the UEG week, was held in 1992 at Athens. UEG has since experienced an enormous growth and success. UEG now incorporates 20 European gastroenterological subspecialty societies and 49 national gastroenterological societies. The annual UEG congress attracts more than 14,000 delegates from all over the world, including also an ever-increasing attendance of North American delegates. Many ESPGHAN members attend the UEG congress regularly not only because ESPGHAN is one of the “founding sisters” of UEG, but also because it is a prime opportunity to exchange with our adult colleagues on recent trends in clinical gastroenterology and related basic science. ESPGHAN is a very active contributor to the activities of UEG through its proactive representation in the Meeting of Members, Education Committee, Scientific Committee, Public Affairs Committee, and the Research Board. ESPGHAN members held positions at the Executive level (UEG treasurer) and currently, our immediate past president Berthold Koletzko is the UEG Council representative for the 11 Medical Gastroenterological Associations that are members in UEG. ESPGHAN benefits from the UEG collaboration in many aspects, including for example significant support for educational activities through educational grants, and added leverage in European lobbying activities through joining forces with the large and professional UEG infrastructure. For example, UEG and ESPGHAN jointly developed a brochure and performed extensive, targeted lobbying activities at the European parliament and European Commission level to raise awareness and support of key challenges in paediatric digestive health, including liver health and nutrition (Fig. 13). There are some first indications that our voices have been heard at least to some extent, given that some of the proposed opportunities have been incorporated into the work programmes of the Horizon 2020 research funding.

FIGURE 13
FIGURE 13:
Brochure on Pediatric Digestive Health jointly developed and distributed at the European Parliament and Commission by ESPGHAN and United European Gastroenterology.

DISTANCE LEARNING (e-LEARNING) IN COLLABORATION WITH UNITED EUROPEAN GASTROENTEROLOGY

An example of very fruitful collaboration between ESPGHAN and UEG is the establishment of a programme for electronic distance learning, which has become a standard educational tool in medical schools around the world. e-Learning is a valuable element that helps meeting the great needs for up-to-date, evidence-based, and applicable information of health care professionals, who are often challenged by time and budget constraints. e-Learning enables easy access from the workplace or from home or abroad, self-paced learning, no travel and onsite costs, and interactivity. Since 2012, ESPGHAN has started to build an e-learning programme that is embedded in ESPGHAN's PGHAN specialist training syllabus (13), supported by the technical and logistic infrastructure of UEG (https://www.ueg.eu/education/online-courses/). ESPGHAN has also partnered with the Early Nutrition eAcademy to jointly develop and implement courses related to nutrition in early life (http://www.early-nutrition.org/en/enea/).

COLLABORATION WITH OTHER PAEDIATRIC ASSOCIATIONS

ESPGHAN regularly collaborates with a variety of European and national paediatric associations, for example, with joint sessions addressing paediatric digestive health at the respective congresses. ESPGHAN has a permanent representation at the European Academy of Pediatrics (EAP) to represent PGHAN at the European Union of Medical Specialists (UEMS) and currently chairs their Tertiary Care Committee. UEMS is the oldest European medical organisation created in 1958 that defines the standards of medical education and training and subspecialty accreditation in the European Union. ESPGHAN also regularly contributes to the programme planning of the biannual EAP congress. It is also partners with the European Paediatric Association – Union of European Paediatric Societies and Associations (EPA-UNEPSA) that was founded in 1976 and serves as an umbrella organisation of 49 national paediatric associations. ESPGHAN has provided the chair of the Scientific Committee coordinating the programme development of the 8th Europaediatrics Congress in Bucharest in 2017 (Tables 6 and 7).

TABLE 6
TABLE 6:
List of ESPGHAN annual congresses
TABLE 7
TABLE 7:
Presidents of the Federation in International Societies for Pediatric Gastroenterology, Haepalogy and Nutrition

FUTURE OPPORTUNITIES AND CHALLENGES

As ESPGHAN has gone from strength to strength during the last 5 decades; it appears to be well prepared to looking forward to the future and to prepare for the challenges and opportunities that the years to come may bring. We continue to strive for further improving our ability to promote child health, to treat and prevent challenges to digestive health in children and adolescents, and to strengthen the knowledge base that is required to do so. Close collaboration among all health professionals involved in this area, along with patients, families, and the many involved stakeholders and decision makers, will be key to achieving our goals. ESPGHAN provides a strong platform and great opportunity for such a fruitful collaboration. The increasing number of young and trainee members in recent years is very impressive and ensures that ESPGHAN remains a young society, but more efforts are needed to support the growth also of allied health professional members and to provide attractive offers for this important group of members, such as the first ESPGHAN allied health professional summer school held in 2017.

The ESPGHAN Strategy Plan 2016–2019 (see supplementary material 1, Supplemental Digital Content 1, http://links.lww.com/MPG/B282) has been developed based on thorough and detailed discussions amongst thought leaders of the Society gathered at the annual ESPGHAN strategy days and the ESPGHAN council, with subsequent discussion with and input from the whole membership. Our Strategy Plan defines our mission, our strategic priorities, and the actions to achieve those and provides a roadmap for the actions to be implemented by the Society in the years after its adoption. Among the identified immediate key goals are that ESPGHAN should provide broad representation for all professionals involved in our field; promote basic, translational, and clinical science; lobby for stronger support of research; offer the highest standards of education to members and all professionals involved in our field; support and defend the health and interests of children, with a special emphasis on gastrointestinal, liver, and nutritional health; and serve as a source of competent advice for institutions and international agencies. Very good progress is being made in all of these areas, thanks to the enthusiastic volunteer work of many members.

ESPGHAN takes pride in its Guidelines and Position Papers. In recent years the number of these generated by Committees, SIGs and WGS has markedly increased. To enable maintenance of high quality standards of our guidelines and position papers, we established rules for a transparent process of their creation and review.

ESPGHAN has a strong tradition in empowering young colleagues and facilitating their qualification in clinical competences and research capability, and it is committed to continue to do so. However, we face challenges due to increasing economic pressures on health systems across Europe, and in particular tertiary paediatric care and academic paediatrics. The reality of tertiary and academic paediatrics is more and more dictated by the income raised from clinical services, while training and academic activities are often not adequately considered and come under pressure, which has at times endangered the quality of training and discouraged talented colleagues to pursue a career in research. Along with other paediatric and medical associations, ESPGHAN must make its voice heard and will have to continue lobbying for providing adequate resources and infrastructures subspecialty medical care, in particular for children.

Today's medicine is based on what science has discovered before, and today's science is tomorrow's medicine. We cannot be satisfied with our current ability to support patients because we do not yet have satisfactory diagnostic and therapeutic strategies available for too many children; hence we must keep moving the borders of our knowledge forward. Much of the progress in our field has previously been driven by talented and dedicated physician scientists that could build a bridge from bench to bedside. The economic pressures in the medical care system make it increasingly difficult to protect time for clinicians’ work in research unless additional grant funding is available. At the same time, research methodology rapidly has become more complex and sophisticated, and it is now difficult if not impossible for a clinician to achieve major progress for her/his patients by doing research work on its own after the regular work hours. There is a real need for close interdisciplinary collaboration and for attracting outstanding basic scientists from various disciplines to get involved in the many burning questions in PGHN. ESPGHAN must strive to attract such scientists to its meeting and the Society to facilitate this essential bidirectional exchange from bench to bedside.

A major achievement of our Society in recent years has been the adoption of the ESPGHAN Code of Conduct that defines the ethical standards and resulting guidelines for the practices and dealings of ESPGHAN. A number of other European associations have looked at the ESPGHAN Code of Conduct and have started to develop similar standards. For example the BioMed-Alliance, an umbrella organisation of 26 European biomedical associations, including ESGPGHAN, that aims to improve the health and well-being of all citizens of Europe through promoting excellence in European biomedical research and advocating for increased funding in favour of biomedical research, in 2016 adopted a Code of Conduct that follows very similar concepts as the one adopted by ESPGHAN in 2015. However, it does not suffice to adopt and publish a written Code of Conduct. Day by day it is of utmost importance to strongly support and defend a culture of honesty, transparency, of resistance against opportunism and against financial allurements that may conflict with our ethical goals, and to support and strengthen and open debate and civil courage within ESPGHAN.

ESPGHAN has a strong tradition of tolerance and inclusion of diversity, and of applying and promoting equality. However, despite the high and rapidly growing proportion of female colleagues particularly amongst our younger members, their representation in the council and the executive council has been less than satisfactory and should be improved. In the now 50 years of ESPGHAN's existence we had only 2 female presidents. We need to get better here.

ESPGHAN has a very strong tradition of collegial friendship, support and collaboration that has its foundation in the spirit of a small society of experts where everyone pretty much knew each other. It is a challenge to maintain this high level of identification of members with their society, which may be the reason for the very large degree of volunteer work that members commit, in a rapidly growing society with a now huge congress. The Summer Schools for young members in training provide an opportunity to create close and lasting friendships and for building strong links of young colleagues to ESPGHAN, but we probably need to keep investing in opportunities for full members to meet and interact such as the ESPGHAN working groups that are accessible for members only, the annual members dinner, and the ESPGHAN master classes. Maintaining and strengthening the high level of dedication of members to ESPGHAN will also be a prerequisite for preserving the high level of volunteer work of our members for the association, even at times when pressures at the workplace tend to increase and the challenge to achieve a work-life-balance may be greater than ever.

The prerequisites for continued importance and success of ESPGHAN are very good, not the least because our core mission is as current as ever: we aim to promote child health through increased understanding, prevention strategies and treatment of diseases. The future developments and strengths of ESPGHAN will most likely have a considerably impact on the lives of children and on their future.

REFERENCES

1. Husby S, Koletzko S, Korponay-Szabó IR, et al. ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and NutritionEuropean Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54:136–160.
2. Agostoni C, Decsi T, Fewtrell M, et al. ESPGHAN Committee on NutritionComplementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008; 46:99–110.
3. Agostoni C, Buonocore G, Carnielli VP, et al. ESPGHAN Committee on NutritionEnteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50:85–91.
4. Host A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999; 81:80–84.
5. Koletzko B, Baker S, Cleghorn G, et al. Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group. J Pediatr Gastroenterol Nutr 2005; 41:584–599.
6. Turner D, Koletzko S, Griffiths AM, et al. Use of placebo in pediatric inflammatory bowel diseases: a position paper From ESPGHAN, ECCO, PIBDnet, and the Canadian Children IBD Network. J Pediatr Gastroenterol Nutr 2016; 62:183–187.
7. Koletzko B, Bhutta ZA, Cai W, et al. Compositional requirements of follow-up formula for use in infancy: recommendations of an international expert group coordinated by the Early Nutrition Academy. Ann Nutr Metab 2013; 62:44–54.
8. Koletzko B, Kolacek S, Phillips A, et al. Research and the promotion of child health: a position paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2014; 59:274–278.
9. Chourdakis M, Hecht C, Gerasimidis K, et al. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. Am J Clin Nutr 2016; 103:1301–1310.
10. Hecht C, Weber M, Grote V, et al. Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr 2015; 34:53–59.
11. Vriezinga SL, Auricchio R, Bravi E, et al. Randomized feeding intervention in infants at high risk for celiac disease. N Engl J Med 2014; 371:1304–1315.
12. Koletzko B, Brands B, Chourdakis M, et al. The Power of Programming and The Early Nutrition Project: opportunities for health promotion by nutrition during the first thousand days of life and beyond. Ann Nutr Metab 2014; 64:141–150.
13. D’Antiga L, Nicastro E, Papadopoulou A, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition syllabus for subspecialty training: moving towards a European standard. J Pediatr Gastroenterol Nutr 2014; 59:417–422.
14. Phillips A, Kelly D, Troncone R. ESPGHAN presents first Distinguished Service Award at AGM 2010. J Pediatr Gastroenterol Nutr 2011; 53:124–125.
15. Troncone R, Shamir R. Presentation of the 2013 ESPGHAN distinguished service award to professor David Branski. J Pediatr Gastroenterol Nutr 2014; 59:1–2.
16. Koletzko B. ESPGHAN Distinguished Service Award 2014 to Professor Peter John Milla, MSc, MBBS. J Pediatr Gastroenterol Nutr 2015; 60:285–286.
17. Koletzko B. ESPGHAN Distinguished Service Award 2015 to Professor C. Olle E. Hernell. J Pediatr Gastroenterol Nutr 2016; 62:793–794.
18. Koletzko B. ESPGHAN Distinguished Service Award 2016 to Professor Deirdre Kelly. J Pediatr Gastroenterol Nutr 2017; 64:169–170.
19. Shamir R. ESPGHAN Distinguished Service Award 2017 to Professor Olivier Goulet. J Pediatr Gastroenterol Nutr 2017; 65:487–488.
Keywords:

child health; code of conduct; codes of ethics; digestive health; nongovernmental organization; nonprofit organization; standard of care; volunteers

Supplemental Digital Content

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