First-of-Its-Kind IBD Board Established at Cleveland Clinic

Inflammatory bowel disease (IBD) can be notoriously complicated to manage, according to Bo Shen, MD, Medical and Endoscopic Management Director of the Inflammatory Bowel Disease Program at Cleveland
Clinic, one of the few medical centers that offers multidisciplinary care for IBD patients at all stages of life. To handle the most challenging cases, Dr. Shen and Tracy Hull, MD, Surgical Section Chief for IBD, have recently launched an IBD Board — the first of its kind in the United States. “Cleveland Clinic is often the last stop for patients with IBD, so we have a mission to help patients find relief,” says Dr. Shen, “and the new Board is part of that mission.”

Modeled on the tumor boards that have been around for some 40 years, the IBD Board held its first meeting on Jan. 1, 2017, and currently meets for an hour every other week on Wednesdays. Typically, three to four cases are reviewed per session, with input from IBD specialists in colorectal surgery, medical and endoscopic management, radiology and pathology. Cases are selected from submissions from within and without Cleveland Clinic to a dedicated IBD Board site that is patient sensitive and HIPAA compliant. Both adult and pediatric cases are accepted. If a case is selected, images and pathology samples are sent to a radiologist and pathologist, respectively, for review. At the meeting, the presenting clinician gives a PowerPoint talk on the case. “IBD is the gift that keeps on giving,” explains Dr. Hull, “so the medical and surgical history may have to go back 20 or 30 years to capture the full story.”

Reaching consensus on complex cases

A variety of questions may be posed about the cases presented, such as whether a patient should have her colon removed. Dr. Hull recounts the case of a female patient with IBD for over 30 years who was suspected of having a precancerous lesion in her colon, and was referred to her for surgical management. Dr. Hull presented the case to the IBD Board, and, in turn, the pathologist on the Board reviewed the biopsy with other expert pathologists, all of whom felt the lesion did not display precancerous changes. Thus, the patient was managed with medicine and followed closely rather than with total colectomy. “The patient was thrilled with this recommended course of action,” Dr. Hull says, “and the referring physician was relieved.”

In another case, a teenage girl with Crohn’s disease was referred to Cleveland Clinic’s pediatric GI department by an outside physician for input as to whether the girl should have surgery or receive biologic medical therapy (e.g., adalimumab, certolizumab, infliximab or natalizumab). After review of the patient’s X-rays, the IBD Board radiologist determined that there might be an abscess in the colon, which would contraindicate administration of biologics. Dr. Hull operated on the girl and did indeed find an abscess along with a perforated hole in the bowel that necessitated colectomy. “In this case, the IBD Board helped to make a life-saving decision,” says Dr. Hull. “If immune-suppressing biologics had been started in the presence of infection, the infection could have spread.”

The ultimate goal of the IBD Board is to provide better patient care through multidisciplinary evaluation. “The IBD Board can give physicians new ideas and offer consensus that their thinking is or is not in line with that of others in the IBD field. In addition, it can offer them reassurance about their treatment decisions,” Dr. Hull says.