Exabis Library

Paediatric onset IBD represents approximately 20 to 25% of cases of IBD. Paediatric onset IBD is subclassified based on age, namely paediatric IBD (10-16 yrs), early onset IBD (6-10 yrs) and the very early onset IBD (younger than 6 yrs). The last group comprises two very young age groups, namely neonatal ( < 28 days) and infantile IBD (1 mo-2yrs). The prevalence of very early onset IBD varies between 3-15% of all pediatric IBD. Very early onset IBD is a heterogeneous disease with a clinical presentation different from adult IBD. Morphologically there are different patterns described, of which the active chronic enteritis show some resemblance with the classical IBD.  In time the morphological features may be become more obvious to diagnose IBD. The other forms shows some morphological features suggestive of a monogenic form of very early onset IBD, such as apoptosis.Clinically the disease is characterized by a more aggressive course with increase in severity, frequently resistant to the standard therapy. In these circumstances genetic counselling is necessary to exclude monogenic forms of very early onset IBD. These diseases require a specific treatment in function of the defect either at the level of the intestinal barrier or in the immunesystem, resulting in different types of immune deficiencies .

The characteristic histological features of inflammatory bowel disease are a disturbed crypt architecture, basal plasmacytosis and granulomas. Numerous diseases may clinically as well morphologically mimic IBD. Hence to make a diagnosis of IBD close communication between clinicians and pathologists is essential. Different types of infections are mimickers of IBD, such as Yersinia, Entamoeba histolytica. An important mimicker, which may give rise to a differential diagnostic problem, is tuberculosis. The incidence of tuberculosis is rising due to immigration, immunodeficiencies, the use of immunomodulators, … Distinction between Crohn’s disease and tuberculosis is essential as treatment is totally different. Differentiation is based on its clinical presentation, morphology and may be confirmed by different ancillary techniques. A main feature is the presence of granulomas in the biopsy or the wall of resection specimen. Different diseases, restricted to the gastrointestinal tract or systemic, are associated with granulomas in the intestine. Hence the presence of a granuloma implies an extensive differential diagnosis.   

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

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.

Educational objectives
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

1. To review recent epidemiologic data, highlighting the importance of environmental factors
2. To understand the complexity and multiple factors contributing to IBD pathogenesis
3. To acknowledge how the complexity of IBD may affect treatment effects

1. To review recent epidemiologic data, highlighting the importance of environmental factors
2. To understand the complexity and multiple factors contributing to IBD pathogenesis
3. To acknowledge how the complexity of IBD may affect treatment effects