This chapter is based on the memories of those who shaped the relationship between the European (ESPGHAN) and the North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Of note is that neither Society had at its origins an “H” in its acronym, as Hepatology was not part of either; the liver at that time was not considered to be important or nobody knew enough about it as to deserve to have it included. No one remembers or will admit to knowing the reason why haepatology was omitted. That changed with time, of course, and the “H” was added to the name of both Societies, which is why in this chapter you may see in some places ESPGAN and in others ESPGHAN. The same is true for the “N” for “Nutrition” in the North American Society; Europeans on the other hand always knew the importance of Nutrition, at least from around 1971. However, at its beginning, the European society was known as ESPGA. NASPGHAN got all letters of its acronym in 2001.
ESPGAN as Inspiration for the North American Society of Pediatric Gastroenterology
In 1986, Dr Jon Vanderhoof, as President of what was then called the North American Society for Pediatric Gastroenterology (NASPG) attended for the first time the annual ESPGAN meeting in Edinburgh, Scotland, as the official representative from North America. Until that time, members of the NASPG met as a group (The Pediatric Gut Club) at one of the national meetings. Dr Vanderhoof, greatly impressed with the ESPGAN meeting, returned to the USA with the strong conviction that NASPG should have a similar, independent meeting in North America. Subsequently, the NASPG Council authorized the very first Society meeting in Chicago in 1989, largely patterned upon the ESPGAN meeting. Organizing such a meeting was challenging because funding was not available and the members of Digestive Disease Week (DDW) were not interested in including pediatric gastroenterology. However, the quality of the ESPGAN meetings served as the inspiration and impetus for what has become the successful annual NASPGHAN meeting.
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
In 1982, the Journal of Pediatric Gastroenterology and Nutrition was founded by Dr Emanuel Lebenthal and was run as a private journal. Also, during the time when Dr Jon Vanderhoof was president of NASPG, several members of the American Society approached him with concerns that the only journal devoted exclusively to pediatric gastroenterology and nutrition had an affiliation with neither of the major academic Societies. Despite the fact that most of the published papers were written by members of NASPG or ESPGAN, there was no editorial input from either Society to publication decisions. The issues involved in changing the status of the Journal were of concern to both NASPG and ESPGAN. Discussions were initiated with Dr Birgitta Strandvik, President of ESPGHAN, and eventually with members of the respective Society Councils, to approach the Founding Editor, Dr Lebenthal, regarding affiliations. Negotiations by the Societies’ Presidents, Dr Birgitta Strandvik and Dr Jon Vanderhoof, and subsequently Dr Jay Perman, as well as the publisher, Raven Press, and Dr Lebenthal were challenging due to competing priorities. Eventually, in 1991 an agreement was signed in Vevey, Switzerland, and The Journal of Pediatric Gastroenterology and Nutrition became the official journal of ESPGHAN and NASPGHAN. In 1995, the other 2 regional Societies, the Latin American (LASPGN) and Asian Pan Pacific (APPSPGN), became affiliates with representation on the editorial board. The Journal has grown steadily and now receives manuscripts from clinical and basic research physicians and scientists worldwide. The Societies publish guidelines, position papers, supplements from major meetings, abstracts from national meetings, and opinions from leaders. The quality of the articles reflected in the rising impact factor is a major reason for the establishment of pediatric gastroenterology as a distinct specialty in the international medical community.
First Joint ESPGAN-NASPGAN Meeting
The First Joint Meeting took place in Paris in 1978. A photo is witness of one of the moments at that meeting (Fig. 2).
Second Joint ESPGHAN-NASPGHAN Meeting
The Second Joint Meeting was organized in New York by Dr William Balistreri, who was Program Chairman. He worked with Drs Jean Rey, Peter Milla, and Beat Hadorn. Dr Richard Grand, from Boston, succeeded Dr Balistreri as NASPGHAN President and chaired the meeting, which took place in 1985 at the now defunct Barbizon Plaza Hotel. At that time, the rate of exchange was such that the dollar was extremely expensive for Europeans and many people complained about the high costs. That at least was not under the control of the organizers. The Farewell Dinner took place at the Essex House Hotel. The Barbizon Hotel went bankrupt shortly after the meeting and NASPGHAN never got a bill for that. That was the first time NASPGHAN's budget showed a positive balance. Since then, NASPGHAN has tried to hold its meetings at hotels likely to go bankrupt, but so far has been unsuccessful and other sources of revenue have had to be found. The Post Graduate Course was then created which became a source of revenue.
The European view of this Joint meeting is summarized in the following paragraphs, taken from the report of the 1985 Annual General Meeting presented by Dr Sandy McNeish's, President of ESPGAN at that time. His wittiness and sense of humour are reflected. This document was provided by one of the authors (S.G.): “The (ESPGAN) Annual General Meeting (AGM) in 1985, a joint meeting with NASPGN, was certainly uniquely memorable, both in its preparation and at the meeting itself. First, the USA organizers had to dismiss the professional conference organizer for incompetence less than one year before the date of the meeting. His replacement was a fast-talking New York lady who appeared to have everything in hand. In fact, the company she represented went bankrupt during the meeting and only sterling work by the local committee saved the day. The scientific programme was of an exceptionally high standard and showed, to this biased observer at least, that European paediatric gastroenterologists can at least hold their own with their American cousins. The symposium on ‘brain-gut peptides’ gave me a headache, not only because of its very high scientific standard, but also because it took place the morning after the welcome cocktail party. At that party, held at the Asia Society on Park Avenue, our hosts had prepared 5 g of food and 1 kg of alcohol for each person. The lunches and the formal banquet on the penultimate night confirmed that the thinking American (or at least the about-to-be bankrupt conference organizer) can eat only chicken and pasta. But the final night was superb - an informal supper in Manhattan, accompanied by 1920's piano. It is only about good friends that you can joke. The 1985 joint meeting was such a success that we agreed unanimously at the AGM to repeat the joint meeting regularly. Amsterdam 1990 followed and, even as I write, we are all looking forward to Houston 1994.”
Although the following pertains more to ESPGHAN proper than to joint relations of the 2 Societies, this document, also transcribed from Dr McNeish's report, was elaborated at the time of the Joint meeting in New York. Because more than 30 years have elapsed and problems have not changed, we believe it is interesting to include it. The following was adopted unanimously at the AGM in New York:
1.1 Paediatric gastroenterology has grown and developed well in Europe in the past decade, largely because of the efforts of members of ESPGAN. Our activities have caught the interest of young workers, and increasing numbers feel sufficiently committed to paediatric gastroenterology to wish to become members of the Society.
1.2 Superficially this can be seen to create a conflict between those who wish to keep the Society small (with the real benefits of easy communication and mutual understanding) and those who wish to allow into membership all who might benefit us.
1.3 Council believes that the guidelines for membership of ESPGAN should be revised to take account of these trends.
- PROPOSED OBJECTIVES
2.1 To maintain, or better to increase, the scientific standards of the Society.
2.2 To offer membership to young workers of high achievement and potential—“to catch them while they are still young.”
- REVISED GUIDELINES
3.1 The applicant should be working in Europe.
3.2 Published evidence of active participation in research of high scientific merit. This is likely to include several papers in refereed international journals.
3.3 At least 1 personal presentation of a paper to the Society.
3.4 No lower or upper age limit will be set. However, it is unlikely that strong candidates for membership will be more than 45 years old.
3.5 Basic scientists, and those in disciplines related to paediatric gastroenterology and nutrition, will be welcomed.
- ADVANTAGES OF THE NEW GUIDELINES
4.1 The introduction of new blood, new ideas, new science.
4.2 Some young colleagues will mature as active members of the Society to the point where they are ready to assume responsibility as Council members and officers when still young.
- POSSIBLE DISADVANTAGES
5.1 The membership could increase to a size, which would cause the AGM to become impersonal.
5.2 This could be minimized by either (a) limiting the number of guests allowed to each member or (b) limiting guests of new members for (say) the first 3 years of membership.
The first new member admitted (by special arrangement) was Professor Rolf Zetterstrom (editor of Acta Pediatrica Scandinavica), boyish in outlook but certainly not a teenager. Nevertheless, the guidelines have become successfully adopted, as can be seen by scanning the auditorium or the dance floor during our recent annual meetings. Despite these stringent bylaws, Drs Jon Vanderhoof, Allan Walker, and Dr Carlos Lifschitz who had (and still do) enjoy ESPGHAN meetings immensely but did not work in Europe, were accepted as members.
Third Joint ESPGHAN-NASPGHAN Meeting
The site selection was summarised like this by the main organizer, Jan Taminiau: “I liked the New York meeting in 1985, went immediately with Hugo Heymans to John Vanderhoof and Dick Grand, proposed Amsterdam that was it.” The meeting took place in 1990 in downtown Amsterdam at the hotel Krasnapolsky. Three hundred people were registered but 600 participants showed up, 300 without any prior notification. According to the organizer Dr Taminiau, the reason was because the weather was nice! Instantly 2 infant milk formula companies came up with the additional budget needed. Old times!
One of the social events took place at the old Binnegasthuis (former Academic Children's Clinic) and the Dutch Youth Orchestra and the imploding piano organized by Werner Herbers, from the Concertgebouw orchestra, performed and one of ESPGHAN members, Beat Hadorn sang opera arias with Ms Nel Biervliet, general pediatrician from Paramaribo, Dutch Guyana. One was “Là ci darem la mano” from Mozart's Don Giovanni. There was also a tour to the open aircraft museum in Enkhuizen with buses and back by boat over the Ijsselmeer to Volendam for dinner at Spanjer hotel. The final dinner took place at the 3-story restaurant at Rokin, and became a standing dinner, as the only way to accommodate the crowd.
Fourth Joint Meeting of ESPGHAN and NASPGHAN
During the period of 1992 to 1994, the relationship between NASPGHAN and ESPGHAN evolved and became closer, due in large part to the interaction of Dr Allan Walker with European colleagues. The NASPGHAN Board of Directors discussed the possibility of holding another joint meeting between the 2 Societies in the United States. Dr William Klish, who at that time was President of NASPGHAN, had offered to hold the meeting in Houston, Texas. He solicited the help of Dr Carlos Lifschitz and with the tremendous help of Margaret Stallings, who worked for the company called SLACK, they began the process of finding a hotel large enough to hold a meeting which could attract 400 to 500 participants. Five hundred and thirteen people attended.
For the 1994 Joint Meeting, there were 186 abstracts submitted by NASPGHAN members and 200 from European colleagues. Seventy-four abstracts were accepted for presentation. A nurses’ program was included. The meeting was held in October and was extremely successful, including participants from South American and Asia. The entertainment was decidedly Texan and included a live private rodeo and Texas barbeque. The rodeo opened to the delight of everyone, with the traditional parade led by Dr William Klish on horseback and Dr Jacques Schmitz, President of ESPGHAN, riding a very large Texas longhorn steer. Tequila shot girls circulated and line dance with instructors put everyone on the dance floor. A special tour and dinner at the National Aeronautic and Space Agency (NASA) was arranged for the farewell dinner. Some people complained that the meeting was getting too large and impersonal. That meeting attracted 513 participants, today they are over 4000!
Fifth and Last Joint Meeting of ESPGHAN and NASPGHAN
This was held in Toulouse in 1998, organized by Jean Pierre Olives at the Centre de Congrès Pierre Baudis. 900 participants attended from 37 countries around the world. The Honorary President was Jean Rey, NASPGN President was Ron Sokol, and ESPGHAN President was Samy Cadranel. The highlights of the Scientific Program were lectures on “Pathogenesis of gastrointestinal and liver disease in cystic fibrosis” by Claude Roy with a presentation and award by Richard Grand, and “Coeliac disease today: new faces of an old disorder” by Jarmo Visakorpi. There were 250 original presentations, consisting of 51 oral and 199 posters. Social Events included a Welcome reception at the City Hall, a concert in the Basilique Saint Etienne, a medieval evening in the old city of Revel and a Farewell Dinner in the “Cloitre des Augustins,” where Stefano Guandalini was elected the next ESPGHAN President.
First World Congress
Building on the success of the Combined NASPGHAN-ESPGHAN meetings and the attendance of colleagues from throughout the world, the leadership of the Asian Pan Pacific Society of Pediatric Gastroenterology and Nutrition (APPSPGHAN), Latin American Society of Pediatric Gastroenterology, and Nutrition (LASPGHAN), and the Commonwealth Association of Paediatric Gastroenterology & Nutrition (CAPGAN) began discussions about organizing a World Congress. Dr Ron Sokol was President of NASPGHAN from 1996 to 1998 and Dr Harland Winter was elected President-elect in 1996. Dr Ulysses Fagundes Neto was a key figure in the development of this project. Each Society made a presentation about hosting the Congress, and at a meeting in Denver in 1997 (Fig. 3), the Presidents decided to hold the First World Congress of Pediatric Gastroenterology, Hepatology and Nutrition in Boston, to be followed every 4 years by meetings hosted by ESPGHAN (2004), LASPGHAN (2008), and APPSPGAN (2012). The agreement between the societies was that each would cancel its annual meeting during the year of the World Congress. Although CAPGAN was not 1 of the 4 sponsoring societies, Dr Peter Sullivan, CAPGAN President, graciously agreed to cancel the already planned meeting in 2000 in order to participate in the World Congress. The Mission Statement of the First World Congress stated: “The purpose of this first World Congress of Pediatric Gastroenterology, Hepatology and Nutrition is to bring together, for the first time, physicians, scientists and other health professionals interested in child health from all over the world to share clinical advances and scientific and technologic developments in the fields of paediatric gastroenterology, hepatology and nutrition.”
Dr Guandalini became ESPGHAN President in 1998 and his vision was that the World Congresses should be the pinnacle of a larger federation that should include the 4 major International Societies for pediatric gastroenterology. He thus began working at this project first within ESPGHAN but immediately also with the NASPGHAN leadership: in 1998, Dr Richard Colletti became President-elect of NASPGHAN and joined Drs Sokol and Winter in organizing the World Congress. Thus, after much discussion that included Ulysses Fagundes Neto and Geoff Cleghorn, the bylaws of this new Federation were drawn and eventually signed in a ceremony held in 2000 in Boston during the World Congress. FISPGHAN (The Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition) was officially created, with the mission to not only be a stable organization to organize all subsequent World Congresses, but also to form international teams (“Working Groups”), to bring together investigators from each Society to work together and develop in specific areas of clinical practice, updated statements on the current state of knowledge, and needs for future research.
The organizational aspects of the World Congress were approved. The host society would retain all the revenue from the Post-Graduate Course and, in addition, 40% of the profit from the meeting. The remaining 60% would be divided among the other 3 sponsoring Societies. The meeting was organized by SLACK, a company that worked with NASPGN in the past to raise funds for the annual meeting and manage all the logistics. About a year prior to the meeting, unexpectedly SLACK decided to sell their meeting business. The President, Harland Winter along with NASPGN leadership negotiated with SLACK to remove NASPGN from inclusion in the sale and Peter Slack agreed to allow Margaret Stallings to get out of her “non-compete” contract and leave SLACK to become NASPGN Executive Director. Jan Sharkey, who continued to be employed at SLACK, worked with Margaret Stallings to raise the funds, organize the meeting, and handle all the logistics. These 2 women did the work of an entire company and saved the First World Congress. Margaret started what has become the NASPGHAN home office, and she remains the highly valued Executive Director of NASPGHAN.
As said earlier, the meeting was organized to emphasize scientific interactions and friendships. The objectives were as follows: to improve the digestive health and nutrition of infants, children, and adolescents worldwide by:
- 1. creating an international forum for communication of the latest scientific, clinical, pharmacological, and technological advances;
- 2. initiating and promoting global collaboration, education, and communication among health professionals;
- 3. fostering basic and clinical research in pertinent issues that impact the paediatric patient, family, and environment;
- 4. encouraging young researchers to pursue scientific investigation into relevant areas.
There were 3 committees that organized the meeting. The International Executive Committee (IEC) that had responsibility for the choice of speakers, selection, and the final approval of the entire scientific program and the marketing of the meeting. The IEC was composed of the current President and President-elect of each of the Sponsoring Societies. The Host Executive Committee was composed of officers and Host Society members who worked with the IEC to organize specific programs, raise funds for the meeting, and insure that Continuing Medical Education requirements were met. In addition, the HEC was responsible to the IEC for (i) selection of meeting site and management company, (ii) budget management, and (iii) oversight of the social activities. A Local Organizing Committee was responsible for the social events and local programs at the meeting.
The 20 working groups, which included a member from each of the 5 societies, served as a mechanism for members to interact. Each group presented its conclusions during a session at the meeting. There were 1138 abstracts submitted as both oral and poster presentations that were reviewed by members from each society by a committee chaired by Dr Mitchell Cohen. Celiac disease had the highest number with 95 abstracts, followed by Helicobacter pylori with 92, oesophageal disorders with 82, inflammatory bowel disease with 79, endoscopy with 69, hepatitis with 66, liver transplantation with 57, and cholestatic liver disease with 47. Twelve abstracts were presented at plenary sessions, 125 were oral presentations, and 971 were posters. Plenary State of the Art lectures were given by:
- 1. Alan Guttmacher, MD, Senior Clinical Advisor to the Director National Human Genome Research Institute, NIH The Human Genome Project on “Genetics and Gastroenterology in the 21st Century”
- 2. Jay Hoofnagle, MD, Director, Division of Digestive Diseases and Nutrition, NIH on “Global View of Hepatitis in Children”
- 3. Benjamin Caballero, MD, The Johns Hopkins School of Hygiene and Public Health on “The Contributions of Nutrition in Child Health: A View from the Global Village”
Decisions about the program were made by the officers of each society by teleconference and at meetings held in airport conference centres. Industry was a true partner in the meeting, providing financial support without requesting any influence on the program. They were acknowledged at the very successful exhibit hall which most of the over 2000 attendees from 80 countries visited. Allocating funds to bring colleagues from resource-poor countries was an important aspect of the meeting and was unanimously supported by the NASPGN Council and the IEC. Resources from the meeting provided funding for 150 young investigators and 50 International Outreach Awards to bring colleagues from Africa, Asia, Eastern Europe, and Latin America including 12 physicians from Cuba. Many of these physicians participated for the first time in a professional international meeting. There was a lunch hosted by the leadership of NASPGN at which representatives from countries in the Middle East met together to discuss the creation of a regional society inclusive of all countries in the region.
In addition to the scientific program, there was an entertaining social program. The Opening Ceremony featured the Boston Ballet II, the young professional arm of the parent company. A reception for organizers was held in the backyard of the home of Harland Winter and Susan Weinstein-Winter (Figs. 4 and 5), the President's Dinner was held at the John Fitzgerald Kennedy Library (Fig. 6), and the Membership Dinner was held at the Boston Aquarium. Live fish was not part of the menu. The Farewell Dinner was at the Museum of Science where Sue, the Tyrannosaurus Rex, greeted everyone and international food stations were located throughout the museum.
The First World Congress provided an opportunity for members and leaders in pediatric gastroenterology from every continent to meet and share experiences. In addition, the editors of the Publication Committee of the Journal of Pediatric Gastroenterology and Nutrition had a meeting (Fig. 7) and the presidents of the World Societies (Fig. 8) and members (Fig. 9).
Subsequent World Congresses
The second World Congress, in Paris in 2004, the third in Brazil in 2008, the fourth in Taiwan in 2012, and the fifth in Montreal in 2016, complete the global cycle. Members of NASPGHAN and ESPGHAN actively contributed with their experience to the organization of forthcoming World Congresses. Figures 10–14 are mementos of the Paris meeting.
As one (C.L.) who has attended the first ESPGAN meeting in Madrid in 1981 and all but 4 since, and comparing them to the NASPGHAN meetings, I was always particularly impressed by 4 things about the ESPGHAN meetings: (1) the large number of topics in nutrition that were presented; (2) the interesting cities where the meetings took place; (3) the social programs; and (4) the comradery that existed among members. At NASPGHAN there was only a business lunch. Unfortunately, regulatory guidelines, costs, and the large number of attendees have restricted social events and time for informal exchanges at ESPGHAN!
What started as a small project has evolved into an international meeting where colleagues from around the world can interact and learn from one another. The leadership of ESPGHAN and NASPGHAN continue to work with colleagues throughout the world to support global health. Unlike most long-lasting relations, this one has been relatively problem free and extremely productive. Hopefully newer generations will continue the traditions and collaboration.