Exabis Library

Ulcerative colitis is a lifelong disease arising from an interaction between genetic and environmental factors, observed predominantly in the developed countries of the world. The precise aetiology is unknown and therefore medical therapy to cure the disease is not yet available. Within Europe there is a North–South gradient, but the incidence appears to have increased in Southern and Eastern countries in recent years. Patients may live with a considerable symptom burden despite medical treatment (66% describe interference with work and 73% with leisure activities) in the hope that the aetiology of ulcerative colitis will shortly be revealed and a cure emerge. Although this is conceivable in the next decade, clinicians have to advise patients on the basis of information available today. Despite randomised trials there will always be many questions that can only be answered by the exercise of judgement and opinion. This leads to differences in practice between clinicians, which may be brought into sharp relief by differences in emphasis between countries.

Two new drugs have recently been approved by the European Medical Agency and one additional strategy will soon follow. With regard to the first part, this includes Filgotinib, an addition to the Janus Kinase inhibitor class with a higher specificity to Jak1. Furthermore, an entire new class has entered the field of IBD by the introduction of Ozanimod the first S1P receptor modulator. Last, anti-IL-23 antibodies are expected to be approved soon. The data of the clinical studies will be shortly summarized and all three drugs will be placed in our current treatment algorithm by discussing efficacy, side-effects as well as the role with regard to extraintestinal manifestations.

Educational Objectives:
1. To understand the mode of action of the three drugs described
2. To review the clinical trials that resulted in the approval of these drugs.
3. To know potential side-effects and required strategies.
4. Identify a possible role within the treatment algorithm.

An overview of the use of 5-ASA, steroids and immunomodulators in IBD 

- Role and efficacy of Fecal microbiota transplantation in IBD
- Role and efficacy of new nutritional intervention in IBD

Alteration in body composition are common in IBD patients and are often not recognized. Rates of obesity in IBD patients are rising over time, driven by gains in fat mass, while lean mass decreases. As (sarcopenic) obesity can independently predict poor disease outcomes during IBD course, the impact of body composition on the IBD disease course will be studied. In this presentation, we will try to unravel whether obesity can lead to the development of IBD and whether IBD can contribute to obesity.

Current literature predominantly uses BMI as a marker of nutritional status. Since augmentation of body composition parameters in the clinical setting could improve IBD outcomes, it is important that clinicians recognize that an increase in BMI may obscure a decrease in muscle mass. This presentation will finish with some practical treatment advices on body composition in IBD patients such as measurement of bio-impedance or hand grip strength alongside with BMI to predict lean muscle mass.

Educational Objectives:
1. To recognize the prevalence of (sarcopenic) obesity in IBD
2. To review the impact of obesity on the development of IBD
3. To understand the impact of obesity on disease course
4. To have an overview of practical measurement tools to reveal body composition in IBD patients

1. To outline the multifactorial etiology of perianal CD
2. To describe advances in diagnosis in perianal CD over the last 10 years
3. To detail advances in medical and surgical therapy in perianal CD over the last decade
4. To understand the different therapeutic options for future management of perianal CD

1) To have an overview of the recent advances in surgery for ulcerative colitis
2) To understand the benefits of the laparoscopic approach for surgery in UC patients
3) to review the possible alternatives to pouch surgery in patients with UC: ileorectal anastomosis, appendectomy, ileostomy, segmental colectomy