ECCO IBD Curriculum
4.1. Understands the importance of multidisciplinary decision making including when radiological, histopathological and surgical opinions should be sought.
This course has been developed for gastroenterologists, surgeons, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). One major aim of ECCO’s e-Learning activity is to increase competence and knowledge with regard to the management of IBD patients and to harmonise diagnostics and treatment of elderly patients with IBD in order to improve patient outcomes.
Learning outcomes: be familiar with the diagnosis and management of IBD in elderly patients
This course is designed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). One major aim of this e-learning activity is to increase competence and knowledge with regard to the prediction, diagnosis and management of stricturing Crohn's Disease (CD) patients and to harmonise diagnostics and treatment in order to improve patient outcomes.
Upon completion of this activity learners will:
- Achieve familiarity with predictors of fibrostenosing CD.
- Understand the role of cross-sectional imaging in the diagnostic work-up of patients with suspected fibrostenosing CD.
- Understand the current management of fibrostenosing CD.
- Recognise the therapeutic capabilities of anti-inflammatory therapy, endoscopic dilatation and surgery in the setting of fibrostenosing CD.
This course has been developed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). One major aim of this e-learning activity is to increase competence and knowledge with regard to the management of CD patients and to harmonise indications and technical considerations for surgery in order to improve patient outcomes.
Upon completion of this activity learners will:
- - Know how to identify surgical indications in patients with Crohn's Disease (CD)
- - Be able to adequately treat different complications in CD patients that require surgery
- - Be able to recommend appropriate changes in perioperative treatment and management
This course is designed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). The intended result of this activity is increased competence, knowledge, performance and improved patient outcomes.
Upon completion of this activity learners will:
- Have insights into the position of surgery versus medical therapy in patients with moderate-to-severe as well as acute severe IV steroid refractory colitis (UC)
- Be able to select the most optimal surgical modalities
- Gain knowledge on the appropriate follow-up of patients with an ileal pouch-anal anastomosis (IPAA)
1. To understand the role of the IBD dietitian in the MDT
2. To review the current dietary approaches for IBD management
3. To discuss whether diet can be used as a prevention strategy
This presentation will provide an overview of current surgical management of IBD with a focus on abdominal and perianal manifestations and treatment of colitis ulcerosa and Crohn's disease, capitalizing on the most recent ECCO guidelines.
1. Typical symptoms presented by a patient
2. Epidemiological IBD data from Austria
3. Ulcerative colitis: typical symptoms, endoscopy examples, complications, extraintestinal involvement, differential diagnoses
4. Crohn´s disease: typical symptoms, clinical investigation, typical endoscpy, differential diagnoses, environmental risk factors, extraintestinal complications
- To understand the different treatment algorithms for treatment of patients with IBD
- To understand the role of patient stratification
- To understand the basics of a treat-to-target strategy
- Tounderstand the different exit strategies
1) Highlight differences in disease presenting in adolescence compared to adulthood
2) Discuss the concept of transition vs transfer and the risks
3) Review the options available for transition and tools used to measure progress
4) Discuss guidelines
IBD are chronic, life-long disorders associated with complex medical, surgical and psychosocial issues. Therefore, IBD clinics need to have a multidisciplinary team to discuss and strategize the most challenging cases. This will enhance quality of care and may reduce disease burden and morbidity. In this session, the IBD nurse practitioner, gastroenterologist and colorectal surgeon will discuss two challenging cases where teamwork is essential.
1. To have an overview of the multidisciplinay team
2. Basics fistulizing Crohn's disease and acute severe ulcerative colitis
3. To understand the multidisciplinary approach
- To understand the key tests and investigations that complete the work up of the presenting symptoms
- To understand the scope of factors that affect IBD patients and which patients need to be educated about
- To learn the principles of a collaborative approach when initiating a treat-to-target treatment strategy
- To recognise the different factors that affect quality of life for an IBD patient and to develop a patient-centred approach to improvement in quality of life.
1. To provide an overview of some of the nutrition and dietary management options for IBD
2. To highlight the role of the IBD nurse in relation to nutrition and dietary management of IBD
Perianal manifestation in Crohn’s disease patients is likely to complicate the disease course with extra intestinal manifestations, abscesses, deep anal canal ulcers, luminal fistulas and strictures, steroid resistance, and need for multiple surgeries. Diagnosis and management of perianal Crohn’s disease implies a multidisciplinary team approach. Diagnosis and definition of perianal disease requires optimal imaging modality, ideally a pelvic magnetic resonance imaging, with an exam under anesthesia (EUA). However, the lack of a definition consensus on perianal fistula in Crohn’s disease may affect standardization of therapeutic approaches and patients inclusion within clinical trial.
The synergic approach by a surgeon and a gastroenterologist is crucial with perianal Crohn’s disease. Drainage of an abscess and possible seton placement to prevent future septic complications is the basic first step of the treatemnt. Ani-TNF drug have shown the best evidence for decreasing perianal drainage and promote fistula healing. Attempting surgical repair is possibile for selected patients. Surgical strategies include subcutaneous fistulotomy, Ligation of the Intersphincteric Tract (LIFT) procedure, or endorectal advancement flap (ERAF). These surgical strategies work best when associated with anti-TNF or immunomodulation and when mild to moderate proctitis is present. More aggressive interventions include diversion of the fecal stream with loop ileostomy and proctectomy; Mesenchymal stem cells have emerged as possible effective treatment and long term results have been demonstrated by randomized clinical trial.
Psychological difficulties are common in people with IBD. In this session I will present the biopsychosocial model of health and discuss how it is involved in the development, maintenance and treatment of IBD. I will discuss how the MDT can support with psychosocial components and why it’s important and briefly discuss the evidence around psychological therapy in IBD.
IBD is a chronic immune-mediated disease that requires continuous patient care. The frequent contact and the good relationship with the multidisciplinary team (MDT) are essential for improving quality of life (QoL) and medication adherence aiming at treatment success. The aim of the study was to assess the importance of MDT in the view of patients with IBD and its impact on QoL and in medication adherence.Methods
A cross-sectional study was carried out, including 114 patients from an IBD reference center in Brazil. The relevance of MDT was assessed through a questionnaire that included the importance of physicians, nurses, nutritionists and psychologists in the patient care. QoL was assessed by IBDQ. Treatment adherence and knowledge about the disease were assessed using the Morisky and CCKNOW questionnaires, respectively.Results
:In total, 69 (60.53%) patients with CD and 45 (39.47%) patients with UC were included. The mean age was 39.16 (±13.50) years and 58.77% were female. The disease duration was 9.88 (±7.35) years. Presence of comorbidities was observed in 52.63% patients. About 57 (82.61%) patients with CD use biological therapy, with a statistical difference (p <0.0001) when compared to patients with UC (37.78%). The gastroenterologist was considered very important by 91.23% of patients, coloproctologist by 62.07% of patients, nurse by 65.05% of patients, nutritionist by 50% of patients and psychologist by 47.25% of patients. In the analysis of QoL, 24 (21.05%) patients had excellent QoL, 52 (45.61%) had good QoL, 29 (25.44%) had regular QoL and 9 (7.89%) had poor QoL, with no difference between patients who followed with nurses or other MDT professionals (Table 1). Medication adherence was low in 58.88% of patients. Knowledge about the disease was low (6.21 ± 3.99 points), being higher among patients with CD (p = 0.01). Patients identify the doctor as the main provider of care for their health, but about 10% leave with doubts from their appointments. 10% of patients think that more care with the nurse is necessary and less than 10% of patients are clarified by the nurse about QoL, ostomies, fecal incontinence, disease activity, biological therapy and sexuality.Conclusion
Patients considered doctors as the most important professionals in their care. Although the service has a multidisciplinary team, not all patients had the opportunity to consult with all professionals, mainly do the Covid pandemic in 2020 and 2021. The lack of contact with the entire team, especially with the nurse, may have contributed to low medication adherence and low knowledge of the disease, impacting disease control and QoL.