Healio Gastroenterology and Liver Disease presents some of the top stories from Advances in Inflammatory Bowel Disease 2019.
The meeting focused on everything IBD, from the latest research to best practices for the IBD doctor. We spoke with several experts who participated in discussions and presentations at the meeting to discover how they handle this challenging disease.
Not dead yet: The role of immunomodulators in IBD
Thiopurine immunomodulators represent a potentially inexpensive and effective method for inflammatory bowel disease maintenance that can be underused as biologics became available, according to a keynote presentation from Advances in Inflammatory Bowel Disease 2019.
“The challenge in our field is that all these other therapies are being marketed by drug companies and there’s no one marketing thiopurines,” Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University Feinberg School of Medicine, told Healio Gastroenterology and Liver Disease. “I have to go back to my predecessors and point out that these were pioneers who have demonstrated a role we now need to put into perspective with all the other therapies that are available.” READ MORE
Diet as therapy for IBD remains hindered by knowledge gaps
As patients with Crohn’s disease seek guidance on how to handle their condition, there remains a knowledge gap regarding what, if any, specific dietary recommendations could become a mainstay therapy, according to a presentation at Advances in Inflammatory Bowel Disease 2019.
“We don’t have enough definitive research to say that one diet is the right answer for patients with Crohn’s disease or ulcerative colitis,” James D. Lewis, MD, MSCE, from the Perelman School of Medicine at University of Pennsylvania, told Healio Gastroenterology and Liver Disease, on the topic of his Rick MacDermott Lecture on diets in inflammatory bowel disease. “However, there is more reason to believe that diet plays an important role in Crohn’s disease based on what we know about the effectiveness of exclusive enteral nutrition for Crohn’s disease.” READ MORE
Early referral does not mean early surgery in IBD
Surgeons have become an important part of an inflammatory bowel disease care team. While there were only a handful of surgeons who participated in meetings with patients, Feza H. Remzi, MD, of NYU Langone School of Medicine, said it is now much more common.
Remzi told Healio Gastroenterology and Liver Disease that having a surgeon as part of a care team should send a message of collaboration to the patient and not an indication that they are being rushed to surgery. READ MORE
Decisions for patients with IBD, cancer must be made case-by-case
Inflammatory bowel disease is a life-altering condition that takes a lifetime of care. Adding it to another life-altering disease, like cancer, makes management decisions much more complicated for physicians, according to experts.
At the Advances in Inflammatory Bowel Disease annual meeting, David P. Hudesman, MD, co-director of the Inflammatory Bowel Disease Center at NYU Langone Health, participated in an expert panel discussing several cases weighing the benefit of IBD drugs with cancer risks. READ MORE
SSNAP: Mnemonic device helps with comanagement of fistulizing Crohn’s
Management of enterocutaneous fistulas in Crohn’s disease does not always get the attention it needs, according to Anita Afzali, MD, MPH, FACG, of the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center.
“When we deal with this, we oftentimes see this as a surgical disease,” Afzali told Healio Gastroenterology and Liver Disease in an interview at AIBD. “When we just send it to our surgeons assuming they’re going to take care of it, then it becomes a struggle.” READ MORE
All C. difficile tests not created equal, especially among patients with IBD
Identifying Clostridioides difficile infection among patients with inflammatory bowel disease can be a particularly tricky task, according to Jessica Allegretti, MD, MPH, of the Brigham and Women’s Hospital Crohn’s and Colitis Center. Since both are diarrhea-predominant, there is a lot of symptoms overlap.
“Distinguishing between C. diff and IBD is very challenging,” Allegretti told Healio Gastroenterology and Liver Disease in an interview. “So how do you do that appropriately?” READ MORE
‘Outcomes will be better’: Therapeutic drug monitoring in IBD
Whether reactive or proactive, therapeutic drug monitoring has become an important part of inflammatory bowel disease care, according to experts.
Raymond K. Cross Jr., MD, director of the IBD program at the University of Maryland School of Medicine, told Healio Gastroenterology and Liver Disease that therapies in IBD can be fickle, and for many patients who initially respond, that effect will be fleeting. READ MORE