1. To overview the current approaches for personalized nutrition in IBD
2. To discuss practical considerations when tailoring dietary recommendations to patients with IBD
2. To discuss challenges and future directions
To emphasize the potential for integration of treatment algorithms with prediction tools in IBD for the personalization of care
To recognize how current algorithms and prediction tools can be used to select biologics in IBD
1. To understand the growing prevalence of IBD in older people.
2. To understand the specific challenges in older patients relating to co-morbidities, polypharmacy and the limited data to guide care.
3. To understand the vulnerability of older patients to the effects of corticosteroids.
4. To discuss immunomodulators, biologics (and surgery) as options in the older IBD patient.
5. To consider carefully an individual's risk of infection, malignancy and their overall fitness in decision-making.
Crohn’s disease is a chronic progressive inflammatory disease of the gastro-intestinal tract that may lead to bowel damage and disability. Half of patients will require surgery within ten years of diagnosis. Unfortunately, surgery is not curative, endoscopic recurrence is reported in 80% of patients within one year of diagnosis, and predicts clinical and surgical recurrence. The prevention of post-surgical recurrence is a critical target in the care of Crohn’s disease after surgery. Currently, postsurgical management and treatment of Crohn’s disease are based on endoscopic monitoring performed during the first year after surgery. However, colonoscopy is an invasive and expensive procedure, unpleasant to patients. Bowel ultrasound is a cheap, non-invasive, readily-available tool for the assessment and the monitoring of patients with inflammatory bowel disease, especially patients with Crohn’s disease. This presentation aims to review the evidence for the use of bowel ultrasound in the specific setting of postsurgical recurrence in Crohn’s disease; the diagnostic accuracy of bowel ultrasound in the detection of postsurgical recurrence in alternative to colonoscopy; its predictive value for clinical and surgical recurrence.
To provide an overview of expanding treatment options in IBD
To provide expert opinion of how to navigate through the different therapeutic options in IBD
1. To review IBD-associated alterations in microbial composition and metabolite production, which contribute to regulation of intestinal inflammation
2. To discuss how these microbiome alterations may serve as future therapeutic targets for precision intervention
1. Overview about Precision medicine
2. Strategies to prevent disease complications: what is in the clinic already?
3. Data on precision medicine in IBD patienst aiming to prevent disease complications
Monitoring has become an essential component of up-to-date IBD patient care. Calprotectin and imaging (ultrasound, endoscopy, MRI) will be discussed as precision monitoring tools with their advantages and disadvantages. A practical algorithm for precision monitoring will be suggested.
1. To understand the therapeutic gap for which predictive biomarkers are needed.
2. To review the current state-of-the art in IBD predictive precision medicine
3. To emphasise the main challenges in biomarker development
4. To prioritise the key areas for research in biomarker development
1. To understand why predicting disease course is important
2. To understand the limitations of existing methods for doing this.
3. To recognise the importance of validating the predictive performance of potential biomarkers
4. To understand methods that are currently being investigated for biomarker development
5. To highlight the first biomarker-stratified trial in IBD (PROFILE) that will determine whether personalised therapy is deliverable from diagnosis
Primary Sclerosing Cholangitis (PSC) is a chronic and progressive cholestatic disease, characterised by inflammation of the intrahepatic and/or extrahepatic bile ducts, progressive fibrosis and scarring of the liver parenchyma and eventually end-stage liver disease. About 70% of patients with PSC have underlying IBD, most frequently ulcerative colitis (UC). Conversely, in patients with known IBD, PSC is found much less commonly, occurring in about 2% to 8% of UC patients and 3% of Crohn’s disease (CD). Despite initial enthusiasm for a genetic link in PSC-IBD, recent genomics data did not show a strong association. Inflammatory bowel disease coexisting with PSC has a specific behaviour and it is considered a distinct phenotype known as “PSC-IBD”. Prolonged duration of IBD is associated with an increased risk of cholangiocarcinoma (CCA) in PSC patients.
-To have an overview on histological features of PSC.
-To understand the association between PSC and IBD.
-To understand the association between PSC and Cholangiocarcinoma.
-To learn features of cholangiocarcinoma.
1. To understand the impact of IBD on the daily lives of patients
2. To review the possible psychological and social issues affecting the quality of life in IBD patients
3. To emphasize the role of the IBD nurse in patient support
Some examples of applying GRADE on clinical questions will be provided, based on our experience with the ECCO Ulcerative Colitis guidelines.
1) Understand the management of rectovaginal fistulas in CD
to discuss the reasons for pouch dysfunction and failure
to explore the results of salvage surgery for the ileooanal pouch
Surgery is highly effective in treating Crohn’s disease, but is not curative, and up to half of the patients would suffer from surgical recurrence, and will require additional surgery. Redo surgery for Crohn’s is challenging, and may include cases who already had multiple surgeries, potentially with intraperitoneal mesh ventral hernia repairs, and imminent short bowel, and this is where sound surgical judgment, combined with superb technical skills are required.
Laparoscopy is a valid option for redo cases. However, even in experienced laparoscopic teams, approximately ¼ to 1/3 of the redo Crohn’s cases are being converted. Convertion should be pre-emptive, before complication occurs, instead of converting because an intraoperative complication has already been occurred.
In redo case, the length of the bowel becomes a prominent issue, and the surgeon should be as bowel preserving as possible on one hand, yet effective to induce remission on the other. Strictureplasty should be considered whenever possible. Side-to-side isoperistaltic strictureplasty results in 37% surgical recurrence in a mean follow-up of 11 years, 1/3 of them were amenable for a second strictureplasty. In Strictureplasty over the ileocecal valve, 14% required additional surgery.
If strictureplasty is not feasible, and resection is mandatory, the common belief is that a large side-to-side anastomosis is associated with better long-term patency. However, The Kono-S anastomosis, preserving the mesentery, has been recently assessed in the SuPREMe-CD trial. At 18 months follow-up, endoscopic recurrence was found in only 25% of the Kono-S patients, compared to 67% in the conventional anastomosis group. This was translated to a significantly lower rate of surgical recurrence in 2 years. On the other hand, Coffey suggested that radical mesenteric resection was associated with significantly lower rate of surgical recurrence compared to historical control. Redo Crohn’s surgery requires experience and expertise, and should be done by dedicated and experienced IBD surgeons.
- To understand the challenges of redo surgery for Crohn's disease
- To review the use of laparoscopy for redo surgery for Crohn's disease
- To discuss bowel length preserving techniques in surgery for Crohn's disease
- To discuss the long term results of different types of anastomosis for surgery for Crohn's disease