An innovative technique to overcomne the actual technical limitations of pouch surgery
Appreciate the scope of issues relating to malignancy in IBD including malignancy related to disease and to medication
Consider the strategies used to mitigate risk of malignancy
Review screening protocols for malignancy in IBD
1. To discuss the diagnosis and management of newly diagnosed ulcerative colitis
2. To determine when and how to switch from one treatment to another to optimize management of ulcerative colitis
3. To examine anti-TNF drug and antibody levels to optimize dosing
4. To discuss preconception counseling to achieve favourable maternal and neonatal outcomes and understand the conditions under which treatments should or should not be stopped during pregnancy and lactation
We present here a case of newly diagnosed ulcerative colitis and will discuss with experts the management strategies in case of persistent disease activity, including the interest of combination therapy and therapeutic drug monitoring to guide management decision.
Preconception counseling to achieve favourable maternal and neonatal outcomes, safety of treatment during pregnancy and lactation, and management of a flare during pregnancy will also be discussed.
1. To review the therapeutic goals and patient needs in UC
2. To confer different treatment strategies in UC
3. To discuss therapeutic options in UC
4. To emphasize the advantage of tight disease control
Educational Objective: to review the incidence, the diagnosis, the optimisation of the patient, and the treatment of entero-urinary fistulas in Crohn’s disease.Historically, abdominal fistulas had an incidence of 35% in Crohn’s Disease (CD) patients. In recent series from Referral Centres, the incidence reported has been as high as of 56% for small bowel locations, and 61% in colonic disease. Urinary fistulas, involving the bladder and the ureter, have a reported incidence of 8-20%. However, in the last decade, the prevalence in large population studies, is inferior to 2%, and it is typical of male gender (75%). In the CD – Clinical Auditing and Research Database (CD-CARD) of “Luigi Sacco” University hospital, among the 1272 patients with 2249 intestinal locations, 908 enteric fistulas were identified, 42 of which were entero-urinary. 86% were entero-vesical and 14% entero-ureteral fistulas. 69% were treated by laparoscopic, and 31% by open surgery, with a cumulative incidence of 5%. Diagnosis of entero-urinary fistulas is based on cross-sectional imaging. Gastro-intestinal Ultrasonography (GI-US), CT scan, and MRI has a sensitivity of 75-80%, that rise to 97% if GI-US is combined with CT scan or MRI. Medical therapy, based of Anti-TNFa is indicated in the presence of inflammatory pattern, with a 45% rate of fistula closure. Surgical treatment is based on the postpone-and-optimize strategy: urine culture and target antibiotic therapy, abscess drainage if present, nutritional improvement, and drug tapering. Preoperative ureteral stenting is indicated when the fistula involves the ureter or the vesical trigon or neck. Laparoscopic approach is indicated whenever technically feasible.
So many 5-ASA trials, so many guidelines - but what is the best dose and route we should be prescribing? According to Dr. Brigida Barberio and colleagues, network meta-analysis supports many aspects of current international guidelines, but highlights a key role for higher doses of oral 5-ASA for induction of remission in more extensive disease.
1. Should the target be histology?
2. Basic histology and definitions
3 Standardization - scoring
4. Histological remission and response
5. Usefulness of histology
6. Possible solutions and improvements
This talk aims to help developers of clinical practice guidelines learn how to use the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to frame health care questions, select and rate the importance of outcomes, grade the quality of evidence, create Summary of Findings Tables, and move from evidence to making recommendations.
1. To understand the way of dosing and administration of ustekinumab in UC
2. To understand dosing, efficacy, side-effects of Tofacitinib
3. To be familiar with the sc administration of Vedolizumab
4. To be familiar with the sc Administration of infliximab
safety and benefit of drug
risk and knowledge about a drug
timing for safety evaluation
To assess differential conditions mimicking the perianal Crohn's disease
To review and recognize proctological lesions not related to inflammatory bowel disease
To have an overview over the main principles of their management
To assist patients with perianal complains
The literature on perianal Crohn's disease lesion focuses mainly on primary lesions, ulcerations, fistulae and strictures. However, patients with IBD may present similar proctological conditions as the general population, which will need to be diagnosed and managed in a way that is appropriate to the general disease. Among these lesions, the diagnosis of common proctological lesions will often be easy, but their management, particularly surgery, will have to be carried out with caution and with a drastic selection of patients. Among the alternative perianal lesion, hydradenitis suppurativa, frequently associated with Crohn's disease, is probably the most difficult to diagnose and its management remains complex. Finally, the management of patients with Crohn's disease should not be limited to the treatment of anatomical lesions, but should also take into account the functional complaints that may largely alter the quality of life of these patients.
1. To review the relative benefits and limitations of drug therapy versus dietary intervention for the treatment of IBD
2. To understand circumstances in which one may consider using drug therapy, dietary intervention or combine the two
3. To consider how treatment paradigms may change in the future to include increased emphasis on the role of dietary interventions
Nathalie Auger and Marianne Bilodeau-Bertrand describe their absolutely enormous epidemiological study of 3 decades of data from Quebec, Canada identifying birth-defects for offspring of almost 22,000 mothers with IBD.