Exabis Library

Learning Objectives:
1. Optimisation, Therapeutic Drug Monitoring of biological
2. Management of anti-drug-antibodies, allergic reaction
3. Strategies PRO / RE-active

Learning Objectives:
1. Acknowledging the risk of cancer in long-standing IBD
2. Surveillance colonoscopy for IBD
3. Managing dysplasia in the IBD setting
4.Surveillance programs and multidisciplinary decision making

5. Surveillance endoscopy
6. Structuring disease, nutrition, endoscopic and surgical options
7. Multidisciplinary decisions

Thinking out of the box. In this talk I will express my personal opinion how surgery can play a role in five year’s time. The role of surgery for IBD moved away from being only a goalkeeper  for complicated disease to first line surgery as preparation for medical management or primarily in combination with medical therapy as well.

Examples will be given: Surgery as first line therapy in limited intestinal Crohn’s, surgery in combination with medical therapy for perianal disease aiming at closure, appendicectomy for all or in selected cases, and what the optimal ileocecal resection must be with respect to type of anastomosis and mesenterectomy.

Educational objectives:
1. To understand the metabolism of thiopurines
2. To understand how thiopurine methyltransferase (TPMT) guides thiopurines dosing
3. To have an overview of the role of thiopurine metabolite testing
4. To understand how shunting of thiopurines affects their efficacy and how this can be corrected

This talk will address the use of thiopurines in inflammatory bowel disease. The talk will  focus firstly on how pharmacogenetic assessment of patients can improve the risk profile of thiopurine therapy and secondly how therapeutic drug monitoring can also improve the safety as well as maximising the effectiveness of thiopurine use

Educational objectives:
1. To understand the metabolism of thiopurines
2. To understand how thiopurine methyltransferase (TPMT) guides thiopurines dosing
3. To have an overview of the role of thiopurine metabolite testing
4. To understand how shunting of thiopurines affects their efficacy and how this can be corrected

This talk will address the use of thiopurines in inflammatory bowel disease. The talk will  focus firstly on how pharmacogenetic assessment of patients can improve the risk profile of thiopurine therapy and secondly how therapeutic drug monitoring can also improve the safety as well as maximising the effectiveness of thiopurine use

This paper is the first in a series of two publications relating to the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn’s disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn’s disease. Surgical management as well as special situations including management of perianal Crohn’s disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].

This paper is the second in a series of two publications relating to the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn’s disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al. JCC 2016].

Intestinal Ultrasound in IBD.
Tip and trick on how to optimise your image

Giovanni Maconi

Intestinal ultrasound (IUS) has become in the last decades an important diagnostic tool for patients with suspected inflammatory bowel diseases (IBD) and for the management and follow up of patients with well-known Crohn’s disease or ulcerative colitis. Thanks to its non-invasiveness and accuracy, the ECCO-ESGAR guidelines recommend IUS as a valuable and practical tool for the assessment of disease activity, monitoring treatment, postoperative recurrence and complications, especially in Crohn's disease (CD).

However, IUS assessment of IBD can be challenging and its accuracy may vary according to targets (e.g. detection, activity, complications), habitus and features of patients, the clinical context,  and sonographer experience. The proper use of sonographic machine and adoption of tips and tricks to optimize bowel visualization are leading points to improve diagnostic yield, assess activity and detect complications. Among the relevant steps ,there are the optimization of gain settings, choose the right probe, appropriately set the color Doppler, use appropriately frame rate and other setting devices such as the Pulse Repetition Frequency (PRF). The real time assessment is also crucial, this includes the appropriate use of the graded compression, change of patients position, and use additional techniques such as the oral or intravenous contrast agents. These steps may be very useful to improve the visualization of the bowel, discriminate specific lesions and conditions and overall to improve sonographic assessment of IBD.