ECCO IBD Curriculum
4.3. Recognises the importance of other healthcare professionals in providing high quality care including nurses, dieticians, stoma therapists, psychologists, and pharmacists.
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 opportunities of virtual clinics for both patients and healthcare professionals
2. To get practical examples from two countries of how to implement virtual clinics
3. To get some advice of what to consider and prepare for concerning virtual clinics
4. To hear the patients opinion about virtual clinics
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.
- 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.
Inflammatory Bowel Diseases are chronic diseases often with complex treatment. The treatment is lifelong and complex and may include several different pharmaceutical groups and sometimes surgery. Not rarely is treatment resistance developed and the treatment may come with different degrees of side effects. Earlier research has shown insufficient to medication adherence and a lower degree of health-related quality of life in patients with inflammatory bowel disease.
The aim is to describe the relationship between medication adherence and health-related quality of life in a Swedish population diagnosed with inflammatory bowel disease. Additional research questions are if any risk factors of low medication adherence can be identified from the collected variables.Methods
This cross-sectional study included N=206 patients from three different regions in Sweden. The questionnaires MMAS-8 and Short Health Scale were used combined with a questionnaire regarding patient characteristics. The data and patient characteristics were described and analyzed using descriptive statistics.
Ethical approval has been received from the Regional Ethical Review Board, Linköping, Sweden (no.: 2015/369-31).
The majority of patients had Ulcerative Colitis (62.6%) There were no significant differences between the different groups of Inflammatory Bowel Disease regarding patient characteristics apart from having gone through surgical procedures, which were more common in patients with Crohn’s disease. A small correlation was shown between medication adherence and the health-related quality of life dimension social function (rho = -0.146; p <0.05). Medication adherence showed no significant correlations to the remaining health-related quality of life dimensions: disease related worry, symptom burden and sense of general well-being. Possible risk factors identified for low medication adherence were age between 30 and 50, working at high occupational level, and higher educational level.Conclusion
The complexity of measuring medication adherence has been established, making it difficult to make any certain conclusions regarding the hypothesis in this report. This study showed no clear association between medication adherence and health-related quality of life in patients with inflammatory bowel disease. However, it visualized the need of optimizing the instruments used to measure medication adherence in individuals with a non-conventional treatment plan
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.