In this talk, we intend to compare the different existing histological scoring systems used in ulcerative colitis, as well as, the standards used for histological response and histological remission.

Educational objectives

1.What are the treatment goals in UC ?
2.Which clinical scores exist for UC ? Are they sufficient ?
3.Which endoscopic scores exist for UC ? Pros & cons ?
4.Which histologic scores exist for UC ? Pros & cons ?
5.When to take biopsies for FU of UC treatment ?
6.What are the treatment goals in CD ?
7.Are there clinical scores exist for CD ? Are they sufficient ?
8.Are there endoscopic scores for CD ? Pros & cons ?
9.How far are we with histologic scores for CD ?
10.Cautious recommendations for pathologists

In this slide seminar a complicated case of IBD in a pediatric patient will be discussed.
Educational objective:
- evaluation of a case in relation of clinical information
- to think on different diagnosis in IBD 

Objectives
1. The role of endoscopy in the surveillance of IBD-patients
2. The diagnosis of dysplasia and its subtypes on biopsies
3. The consequences for the treatment of the patient

Due to the continuous inflamed state of the mucosa, ulcerative colitis and Crohn’s disease patients are at risk of developing colorectal cancer at an earlier age and with a poorer prognosis. Hence continuous endoscopic surveillance with sampling of biopsies is necessary to detect the preneoplastic lesions in an early stage.  The SCENIC classification is a new endoscopic classification, which categorizes the lesions in to invisible and visible dysplasia.. Histologically these lesions consist of different subtypes, of which the adenomatous type is the most common. The presence of an inflamed mucosa complicates its diagnosis, resulting in a high interobserver variability in the categories indefinite for dysplasia and low grade dysplasia. Hence the ECCO-guidelines recommend to confirm the diagnosis of dysplasia by an expert pathologist in gastrointestinal pathology.

Eductional objective: To illustrate a rare mimicker of IBD pathology.

A middle-aged woman of Turkish origin complained of abdominal pain, watery diarrhea and vomiting since 3 weeks.
Lab tests were negative. Colonoscopy showed moderate to severe, patchy pancolitis.
Pathology was unclear.
She was treated with antibiotics and painkillers.
She went first into remission, and then did a relapse after one month.
At this time there was also arhtritis and oral as well as genital sores.
Colonoscopy showed patchy ulceration with dense perivascular inflammatory cell infiltrates, but without granulomas.

Your diagnosis?

Ulcerative Colitis and Crohn's disease have different macroscopic appearances.
Both diseases show unique and peculiar macroscopic features and it is important to recognise them in order to sample IBD specimens correctly.
The macroscopic examination is the first step for a correct pathological analysis and it is essential for the histological examination.
Educational objectives:
-To identify basic macroscopic features of UC and CD.
-To sample the specimens correctly.
-To recognise elementary lesions.
-To do not underestimate IBD samples.

Educational objectives:
•Synthesis and structure
•Mechanism of action
•Effects on inflammatory and immune processes
•Pharmacology  and formulations
•Efficacy of steroids as anti-inflammatory agents in inflammatory bowel diseases (IBD)
•Safety and complications

To understand the value of pathology in reporting/documentation of the course of IBD diseases
To understand the value of pathology in guiding surgical treatment of Crohn and ulcerative colitis

1. To understand the surgical strategies and surgical implications of surgery in IBD
2. To review surgical techniques and decision making in surgery for IBD
3. To emphasise multidisciplinary team working and patient involvement in decision making
4. To promote the role of the specialist IBD nurse in providing care, education, and counselling to Crohn and colitis ulcerosa patients

To understand the differential role of MRE and intestinal ultrasound (IUS) in the diagnostic work up of IBD

Educational objectives:

1. What is the role of appendectomy in the clinical course of UC?

2. Can appendectomy prevent colectomy for UC?

3. Who will respond to appendectomy?

4. Patients with ulcerative appendicitis are more likely to respond to appendectomy

5. The presence of PARP is predictive of ulcerative appendicitis 

1. To review the goals achieved in Imaging of IBD during the past few years and the new challenges for the next future
2. 1. To understand the future directions of imaging for IBD
3. To have an overview of the current and future role of AI in Imaging of IBD

Educational objectives:

1. Recognize the importance of diet in IBD and the interaction with microbes
2. Diet: not just feeding ourselves
3. ‘Functional foods’: diet as a microbe-altering treatment
4. Discuss what microbe-targeted diet therapy in IBD might look like in the future

Summary:

Both microbes and diet are likely to be involved in the pathogenesis of IBD and some studies suggest that it is the interaction between diet and microbes that offers opportunities for understanding why IBD develops and possibly even offer therapeutic options. Key to this is the recognition that elements in our diet specifically target and influence the microbes and that altering the diet could impact IBD, through effects on microbes.

This talk will focus on how this knowledge and area of research is likely to evolve in the future, highlighting the importance of specific food compounds (such as fibre), the use of complex research tools (including metabolomics), the development of personalized diets, and how this all might impact patient care, and perhaps even disease prevention. While this field is still in very early stages of development, there is much promise that diet will have a major impact on IBD care in the future, through defining impacts on microbes. It is important for both dietitians and those involved in diet research in IBD to be aware of this evolving field.

Educational objectives

1-    To understand that IBD are associated with worse quality of life and high rates of depression, beyond symptoms alone.

2-    To consider the role of psychological components on postoperative outcomes

3-    To understand the rationale and results of our study

4-    To understand the rationale for preoperative psychological support in IBD patients

Summary

Background: Inflammatory bowel diseases lead to increased rates of depression and reduced quality of life (QoL), beyond intestinal symptoms alone. QoL seems to improve at 1 year after surgery, but not in the short term. No studies have explored the potential role of psychological components (mindfulness in particular) on postoperative outcomes. 

Aim: the aim of this pilot-study was to explore the correlation between a set of psychological predictors, QoL and surgical outcomes.

Methods: psychological questionnaires were administered before surgery. QoL questionnaires were administered both preoperatively and at 30- 90 days and 6 months after surgery. Length of stay (LOS), postoperative pain and complications were also evaluated. 

Results: 30 patients were enrolled(56% Crohn’s - CD, 44% ulcerative colitis - UC). 67% were males. Mean age was 43,5, mean BMI 22,6. Most patients were ASA 2(70%). Smoke habit was reported in 17%. Charlson Comorbidity Index was 0 in 54% of patients, 1 in 23%, 2 in 17%, 3 in 3% and > 5 in 3%. Index procedure was ileocecal resection in 47% of cases, total colectomy in 13% and restorative proctectomy in 40%. Mean operative time was 186 minutes. In 53% of patients a temporary stoma was performed. No differences in baseline psychological characteristics were found between CD and UC patients. Higher levels of stress(PSS) (P=0.0008), anxiety(HADS-A)(P=0.028) and depression (HADS-D)(P=0.028)were correlated with worse preoperative QoL. No correlation was found between preoperative psychological predictors and LOS, postoperative pain and functional recovery (time to 1° bowel movement). However, the logistic regression model found a correlation between postoperative complications and Anxiety(HADS-A). Patients experienced a significant increase in QoL after surgery(30 days, P=0.008; 90 days, P=0.005). Patients with higher QoL and Cognitive Flexibility Scale scores at baseline had more probabilities to experience a significant improvement 30 and 90 days after surgery(P<0.0001; P=0.04).

Conclusions: stress, anxiety and depression impacted on preoperative QoL. Anxiety correlated with postoperative adverse outcomes. Cognitive flexibility had a positive effect on QoL improvement at 30 and 90 days after surgery. Patients with higher baseline QoL were more susceptible to improve their QoL over time after surgery. 

-          To review the frequency and type of pancreatic manifestations in IBD

-          To have an overview of the morphological features of chronic and autoimmune pancreatitis

-          To emphasise the role of histopathology in the diagnosis of pancreatic manifestations in IBD

Pancreatic changes are present in up to 50% of IBD patients, but symptomatic disease is rare and mostly related to acute pancreatitis, chronic pancreatitis or autoimmune pancreatitis.

Acute pancreatitis in patients with IBD is usually related to gallstones or drugs (thiopurines, mesalamine) and is more common in Crohn’s disease (CD) than in ulcerative colitis (UC).

Chronic pancreatitis is quite rare and thought to be idiopathic or possibly related to obstruction, e.g. in patients with primary sclerosing cholangitis. There is no possibility to specifically diagnose IBD-associated chronic pancreatitis, and diagnosis is usually one of exclusion.

Autoimmune pancreatitis (AIP) is more frequent in IBD patients than in the general population, but it remains a rare disease. IBD, and especially UC, are most frequently associated with type 2 (= non IgG4-related) AIP and this association is characterized by an active and more aggressive disease with higher rates of colectomies. There are definite histopathologic criteria for the diagnosis of AIP, which can be successfully applied on biopsy material. Therefore, if AIP is suspected in IBD patients, a pancreatic biopsy can be useful to confirm the diagnosis and direct therapy.

1. To understand the impact of IBD on daily life.
2. To understand the concept of patient-reported outcomes (PRO).
3. To learn how to use the IBD-Disk in clinical practice.
4. To understand the main clinical factors associated with disability in IBD.

Educational objectives:
1. To understand the metabolism of thiopurines
2. To understand how thiopurine methyltransferase (TPMT) guides thiopurines dosing
3. To have an overview of the role of thiopurine metabolite testing
4. To understand how shunting of thiopurines affects their efficacy and how this can be corrected

This talk will address the use of thiopurines in inflammatory bowel disease. The talk will  focus firstly on how pharmacogenetic assessment of patients can improve the risk profile of thiopurine therapy and secondly how therapeutic drug monitoring can also improve the safety as well as maximising the effectiveness of thiopurine use

1. To understand the role of dietary patterns in development of CD
2. To review the position of dietary therapy in current ECCO-ESPGHAN guidelines
3. To discuss novel dietary strategies based on recent evidence
4. To show how microbiome and metabolome can affect induction and maintenance of remission