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

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

Educational objectives:
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

Summary

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.

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.