Exabis Library

The incidence of lymphoproliferative disorders (LD) is increasing in developed countries. Patients with inflammatory bowel disease (IBD) exposed to thiopurines are at additional risk of three specific forms of LD: Epstein-Barr-Virus-related post-transplant like LD, hepato-splenic T-cell lymphoma and post-mononucleosis lymphoproliferation. The risk of the two latter forms of LD can be reduced when considering specific immunosuppressive strategies in young males. It is still unclear whether the risk of uterine cervix abnormalities is increased in IBD women, irrespective of the use of immunosuppressants. Given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate. Patients with IBD receiving immunosuppressants are at increased risk of skin cancers. The risk of non-melanoma skin cancer is notably increased in patients receiving thiopurines. Recent data suggest that the risk of melanoma is mildly increased in patients exposed to anti-TNF therapy. All IBD patients should adhere to a program of sun protection and dermatological surveillance, whose details should take into account the other non-IBD-related risk factors.

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:
1. Eyes
2. Primary Sclerosing Cholangitis
3. Rheumatology
4. Skin disease

Upon completion of this activity learners will have gained knowledge on the manifestations of IBD as connected to:

• Eyes
  
• Primary Sclerosing Cholangitis
  
• Rheumatology
• Skin

Learning Objectives:
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

Lara Hart discusses her team’s work capturing faecal calprotectin values in a large cohort of patients with clinically quiescent ulcerative colitis undergoing colonoscopy, and reports test performance for predicting ongoing endoscopic or histologic disease activity.

Julien Verdier reports the work of the team at INSERM, Paris, analysing microRNA expression in faeces and considers the significance of the differences they observed between patients with active disease and controls.

Educational objectives:
1. To understand the rationale for FMT as a treatment for IBD.
2. To be updated on trial data for FMT in IBD.
3. To understand some emerging predictors of efficacy for FMT in IBD.
4. To understand the infrastructural needs for FMT as a therapy.
5. To understand the evolving regulatory landscape and governance issues for FMT.