Exabis Library

Ulcerative colitis and Crohn’s are both chronic inflammatory bowel diseases, associated with an increased risk of colitis-associated cancer secondary to the longstanding and severe intestinal inflammation. To reduce this risk patients are treated with drugs such as immunomodulators and biologicals. Studies however have shown that these therapies may be associated with an increased risk of extra-intestinal cancers as e.g. haematological malignancies, skin cancer, cervix cancer. Different types of drugs are associated with different types of cancer, e.g. patients treated with thiopurines are at risk of haematological malignancies, such as lymphomas, and non-melanoma skin cancer, whereas a relationship between melanoma and biologicals has been described. Therefore, the benefits and harms must be considered in treatment decision. To reduce the risks of malignancy it is advised temporarily interrupt treatment or restrict the use of certain drugs to a limited time. To avoid skin cancer sun protection and skin surveillance is recommended.

Many neoplastic complications are described in IBD these could be due to the desease or to the treatment. In this presentation we will focus on a case of multiple neuroendocrine tumors in a patient with Crhon's disease.
Educational objectives:
- to know the main neoplastic complications in IBD
- to understand the possible etiology.

1. To review the literature concerning neuroendocrine proliferations in IBD

2. To look at some examples of cases of neuroendocrine tumours

3. To discuss neuroendocrine micronests/microcarcinoids

To understand neuromuscular complications in IBD including secondary / medication induced changes and extraintestinal involvement of neuromuscular system.

In the last week of February 2020 hit Stockholm with increasing number of cases starting to appear at hospitals in the region. This prompted a rapid mobilisation of large scale biobanking and immediate immunological analysis at the Karolinska Institutet with the aim to understand COVID-19 disease pathogenesis. Fairly soon the Karolinska COVID-19 Immune Atlas was launched as an online resource providing scientists rapid access to biological data. In this talk, the research response to the pandemic will be discussed.

Educational objective:
To undertand the role human translational immunological research have in shedding light on disease mechanisms

1) Description of immune pathways that drive inflammation in IBD
2) Discussion of the pathways targeted by current and future therapies
3) review of clinical evidence supporting use of novel therapies (selective Jaki, Sphingosine modulators, anti p19 therapies)
4) Highlight the data on adverse effects of new therapies
5) Stem cell therapies for perianal fistulae
6) Discuss novel formulations of existing agents (low systemic bioavailable steroids)

1. To understand the role of advanced endoscopic technologies for  disease activity and  mucosal healing  assessment  in UC.
2. To review  the new Virtual Electronic Chromoendoscopy 'The PICaSSO''score  in UC and its correlation with histology 
3. To review  the new PICaSSO Histological Remission index in UC and its practicality 
3. To emphasise the implementation  of the  PICaSSO endoscopic  and histological scores into Artificial Intelligence  

Several surgical techniques have been described aiming perianal fistula healing in CD.
In this lecture, we will discuss evidence of the following approaches: advancement flaps, LIFT, anal plug, fibrin glue injection, VAAFS, stem cells, vaccum assisted dressing among others.
There is still no superior technique aiming healing of perianal fistulas in CD.
Treatment should be individualized.

1. Diagnosis of the uncommon mimickers of IBD, which should be morphologically distinguished as treatment is totally different from IBD. The mimickers discussed are infection, drugs, vascular disorders and immune-related disorders.

The characteristic histological features of inflammatory bowel disease are a disturbed crypt architecture, basal plasmocytosis 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. Mimics of IBD include SCAD (segmental colitis associated with diverticulitis), diversion colitis, infections, drugs, vascular disorders and immune disorders, of which the latter are less common. In order that the pathologist can make a distinction between these mimics, information about the clinical  history, endoscopy, imaging, microbiology, serology is required. This information as well as subtle histological features may help in this differential diagnostic process. Exclusion of these mimickers is essential as they most commonly require a totally different treatment.