Highlights from IBD Horizons
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In this guest commentary, Anita Afzali, MD, medical director of the Inflammatory Bowel Disease Center at The Ohio State University Wexner Medical Center, discusses the highlights from the recent IBD Horizons conference held Feb. 29, in Columbus, Ohio.
IBD Horizons was founded 6 years ago in Seattle, Washington by myself, Scott D. Lee, MD, director of the IBD Program at the University of Washington in Seattle, and Ghassan Wahbeh, MD, director of the IBD Center at Seattle Children’s Hospital. We held the third annual symposium in our second host city of Columbus, Ohio. In this conference, we aimed to be different from typical conferences. We come directly to the community and provide evidence-based, updated content, and free CME/CNE education on topics related to IBD.
We have about 200 attendees at these symposiums, with numerous specialties represented, including GIs, surgeons, rheumatologists, dermatologists and OB-GYNs, and distinguished IBD experts and speakers. Our main focus is to keep the audience engaged and the symposium is very interactive. We have a unique format, where each faculty speaker presents for no more than 10 minutes, followed by 20 minutes of an interactive faculty panel discussing real-world cases and questions. Audiences are provided tablets through which they can remain engaged, ask questions and challenge the panel on the topics. As the panel discusses along with audience engagement, we learn that managing patients with IBD can be complex, with many nuances and caveats that requires shared decision making for patient care.
Our IBD faculty experts covered a wide range of topics that generated lively discussions between the faculty and the audience. The following are just a few of the highlights from the 3rd Annual Midwest IBD Horizons symposium.
Promising Pathways and Upcoming Agents in IBD
Each year we invite Brian G. Feagan, MD, from the Robarts Research Institute at the University of Western Ontario, and an honorary board member of IBD Horizons, to discuss the new treatment pathways and introduce newer therapies in the horizon. During the discussion, we help attendees gain a better understanding of which patients they should consider for clinical trials, as well as timing of referrals for a study or investigational drug. For the practicing GI in the audience, they learn not only what is in the pipeline, but they learn how they can be involved in the research and development of therapies to come in IBD.
Managing Fibrostenotic Crohn’s Disease Complications
This session emphasized that fibrostenotic Crohn’s is an aggressive disease phenotype that requires careful management not just by a GI, but also by surgeons. Specifically, we discussed the proper times to treat medically and when to refer to surgery. There are also endoscopic options for management of bowel strictures, such as through the scope balloon dilation. Choosing which approach is best, whether medical therapy, endoscopic or surgical intervention could be challenging, and this topic was very informative and provided a practical algorithmic approach about how practicing GIs should treat fibrostenotic disease.
Application of the Treat-To-Target Concept in Clinical Practice
The topic of treat-to-target may appear algorithmic, but often requires an individualized approach as the targets may be different for each patient. These targets, which includes patient reported outcomes and symptoms, as well as objective targets such as endoscopic assessment and resolution or improvement of disease on cross sectional imaging, helps both the clinician and the patient understand what to aim toward for optimization of therapy and improved disease outcomes. Importantly, what may be one patient’s target is going to be very different from another patient. A successful treat-to-target approach requires both a willing patient and an informed provider. Monitoring strategies after targets are reached can also potentially be used for de-escalation of therapy for the appropriate IBD.
Cannabis and Alternative Therapy in IBD: Good, Bad or Ugly
This seems to be a hot topic of interest and raised a significant amount of discussion. Marijuana use among IBD patients is common and providers need appropriate information regarding its potential benefits and risks. While they might experience some benefits in the form of symptomatic improvement, we have not seen any data that show actual improvement in disease inflammation. In fact, there may be an association of poorer disease outcomes and infection risk. This was a practical discussion with the community GIs so they can discuss it comfortably with their patients. We want the attendees to have the information they need to counsel their patients effectively.
We hope you will join us in Columbus, Ohio for the 4th Annual Midwest Symposium February 27, 2021 or in Seattle, Wash. for the 6th Annual Pacific Northwest Symposium March 6, 2021. (www.ibdhorizons.org)
Disclosure: Afzali reports acting as a consultant for AbbVie, Celgene, Janssen, Takeda and UCB; and receiving speaker fees from AbbVie, Janssen, Pfizer, Takeda and UCB. She is also the founder and board member of IBD Horizons.