Exabis Library

1) Overview of the aetiology of IBD
2) Discussion of the impact of the environment on disease onset, course and response to therapy
3) Focus on the emerging evidence of a role of diet on disease onset from animal models, epidemiology and human studies
4) Discussion of the potential to modify the environment as a preventative strategy / therapy

Learning Objectives:
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

safety and benefit of drug 
risk and knowledge about a drug 
timing for safety evaluation 

To assess differential conditions mimicking the perianal Crohn's disease
To review and recognize proctological lesions not related to inflammatory bowel disease
To have an overview over the main principles of their management
To assist patients with perianal complains


Summary

The literature on perianal Crohn's disease lesion focuses mainly on primary lesions, ulcerations, fistulae and strictures. However, patients with IBD may present similar proctological conditions as the general population, which will need to be diagnosed and managed in a way that is appropriate to the general disease. Among these lesions, the diagnosis of common proctological lesions will often be easy, but their management, particularly surgery, will have to be carried out with caution and with a drastic selection of patients. Among the alternative perianal lesion, hydradenitis suppurativa, frequently associated with Crohn's disease, is probably the most difficult to diagnose and its management remains complex. Finally, the management of patients with Crohn's disease should not be limited to the treatment of anatomical lesions, but should also take into account the functional complaints that may largely alter the quality of life of these patients.

Educational objectives:
1. To understand growth impairment in paediatric IBD resulting from disease activity & treatment choices
2. To review the current ECCO/ESPGHAN treatment algorithm with regards to growth optimization
3. To provide an overview of strategies to minimize IBD activity-related growth impairment
4. To emphasise the importance of reducing steroid-exposure and improving skeletal growth and lean body mass