Exabis Library

1. To understand the impact of IBD on daily life.
2. To understand the concept of patient-reported outcomes (PRO).
3. To learn how to use the IBD-Disk in clinical practice.
4. To understand the main clinical factors associated with disability in IBD.

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

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.

Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Efficacy and safety of tofacitinib were evaluated in randomised, placebo-controlled Phase (P)2 (NCT00787202) and P3 (NCT01465763; NCT01458951; NCT01458574) studies, an open-label, long-term extension (OLE) study (NCT01470612) and an ongoing P3b/4 study (NCT03281304). We report updated tofacitinib safety analyses from the tofacitinib UC clinical programme, with inclusion of a 6‑month interim analysis of data from the P3b/4 study, up to 7.8 years of tofacitinib exposure.

This analysis included1157 patients (pts) receiving tofacitinib 5 or 10 mg BID from completed P2/P3/OLE studies, and the ongoing P3b/4 study (as of 20 Feb 2020; Overall+P3b/4 Cohort). Proportions and incidence rates (IRs; unique pts with events/100 pt‑years [PY] of exposure) were evaluated for deaths and adverse events (AEs) of special interest. Opportunistic infections (OIs), malignancies, major adverse cardiovascular events (MACE) and gastrointestinal perforations were adjudicated.

Table 1 shows demographics and clinical characteristics. In the Overall+P3b/4 Cohort, 1157 pts received ≥1 dose of tofacitinib 5 or 10 mg BID; 955 (83%) received a predominant dose of 10 mg BID; 397/1157 (34.3%) pts had received tofacitinib for >4.1 years. Median treatment duration was 623 (range, 1–2850) days (2999.7 PY of exposure). Table 2 shows safety data for AEs of special interest in the Overall+P3b/4 Cohort. IRs (95% confidence intervals) for all tofacitinib doses: deaths, 0.23 (0.09, 0.46); serious infections, 1.69 (1.26, 2.21); herpes zoster (non-serious and serious), 3.30 (2.67, 4.04); OIs, 1.03 (0.70, 1.46); malignancies (excluding non-melanoma skin cancer [NMSC]), 0.84 (0.55, 1.24); NMSC, 0.73 (0.45, 1.10); MACE, 0.29 (0.13, 0.55); deep vein thrombosis, 0.03 (0.00, 0.18); pulmonary embolism, 0.19 (0.07, 0.42); and gastrointestinal perforations, 0.10 (0.02, 0.28). IRs for AEs of special interest were similar to prior Overall Cohort analyses.¹

The safety profile of tofacitinib in pts with UC from the tofacitinib UC clinical programme was generally consistent with that of other UC therapies, including biologics, with the exception of herpes zoster.² IRs for AEs of special interest have remained stable over an extended period of time (up to 7.8 years) with inclusion of final data from the OLE study and an interim analysis of data from the P3b/4 study.^1,3

References:
1. Sandborn WJ et al. United European Gastroenterol J 2021; 9 (Suppl 8): Abstract OP152.
2. Curtis JR et al. Inflamm Bowel Dis 2021; 27: 1394-1408.
3. Sandborn WJ et al. United European Gastroenterol J 2020; 8 (Suppl 8): Abstract OP494.

Bobby Lo discusses his work measuring the impact of IBD on healthcare costs and the wider economy in a Danish cohort and provides some interesting insight into the Danish healthcare model.

Paediatric Inflammatory Bowel Disease (IBD) accounts for 10-15% of all incident cases, while incidence in children under 10 years old is rising most rapidly. Very early-onset inflammatory bowel disease (VEOIBD) is diagnosed before the age of 6 years while infantile IBD occurs before the age of 2 years and may be a clue for monogenic IBD..

It is very important to identify monogenic IBD patients as management may differ from classical IBD. While age of onset is most relevant, specific comorbidity and extraintestinal manifestations also are of particular relevance in identification of monogenic IBD. These conditions are summarized in the following: Young agematters most. Young age onset; Multiple family members and consanguinity; Autoimmunity; Thriving failure; Treatment with conventional medication fails; Endocrine concerns; Recurrent infections or unexplained fever; Severe perianal disease; Macrophage activation syndrome and HLH; Obstruction and atresia of intestine; Skin lesions, dental and hair abnormalities; Tumours. This anagram will be further elucidated.

A diagnostic algorithm of monogenic IBD will be discussed, incorporating multidisciplinary team assessment of genetic results, genetic counselling but also the need for functional assessment of novel gene defects and variants of unknown significance to establish causality. Also, illustrative cases of monogenic IBD such as Interleukin-10 receptor deficiency and XIAP will be incorporated in the presentation.