ECCO IBD Curriculum
7.10. Understands the management of extraintestinal manifestations of IBD
This e-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 Extra-intestinal Manifestations and to harmonise diagnostics and treatment in order to improve patient outcomes.
This course examines a series of cases on:
2. Primary Sclerosing Cholangitis
4. Skin disease
Upon completion of this activity learners will have gained knowledge on the manifestations of IBD as connected to:
- Primary Sclerosing Cholangitis
1. Prevalence and management of EIM
2. Identification of muco-cutaneous EIM and therapy
3. Classification and therapy of rheumatological EIM
4. Classification, prevalence and management of EIMs
5. Identification and therapy of muco-cutaneous EIMs
6. Identification, classification and therapy of musculoskeletal EIMs
1. Screening before immunosuppression and immunisation
2. Indications for biological therapy
3. Evaluation of response
IBD patients are eligible to treatment with biologic agents if they have failed or cannot tolerate conventional treatment with corticosteroids and/or immunomodulators (IMMs) or are corticosteroid dependent. Early introduction of biologic therapy is also recommended for patients who at diagnosis have clinical features that predict a disabling course of disease. Ideally, patients should be screened for infectious diseases, malignancies, and complete all essential vaccinations before starting any therapy. Selecting the best biologic amongst the currently available different classes, depends on several patient- and disease-related parameters, such as age, disease activity, comorbidities, and the overall burden of disease. As for any therapy, it is important to define short-, medium- and long-term goals, monitor the progress of disease and adapt treatment accordingly (treat to target).
The first biologic is the best shot. Thus, it is key to adapt dosing to disease activity to avoid primary non-response or partial response and thus achieve a better long-term response. Co-treatment with an IMM may influence the pharmacokinetics in particular of anti-TNF and prevent early development of anti-drug antibodies ADA). Once clinical remission has been achieved, patients should be closely followed by monitoring clinical activity (patient reported outcomes), biomarkers (serum CRP, faecal calprotectin), imaging (US, MRE), endoscopy and/or histology. Treatment optimization in case patient loses response can be achieved either empirically (Standard of Care) by increasing the dose of the biologic or halving the administration interval, or both, or by adding an IMM, or by therapeutic drug monitoring (TDM), i.e., by measuring drug levels and ADA. Pro-active TDM has not been proven superior to reactive TDM, still, it serves to discriminate between pharmacokinetic and pharmacodynamic failure of treatment. However, proactive TDM is increasingly used to achieve clinical response and/or remission during induction, to de-escalate, or stop biologic therapy.
4. Screening before immunosuppression and immunisation
5. Indications for biological therapy
6. Evaluation of response