What Not to Miss at Advances in Inflammatory Bowel Disease 2018

This year’s Advances in Inflammatory Bowel Disease (AIBD) conference will feature highly practical educational sessions that tackle tough clinical problems and include back-and-forth exchanges between presenters and listeners. This new type of case-based, open session was first offered four years ago and proved highly popular. Last year, AIBD included one such session; this year the conference will offer two.

“These two sessions will get into the hottest of hot topics that concern physicians,” says conference co-chair Miguel Regueiro, MD, Chair of the Department of Gastroenterology, Hepatology and Nutrition at Cleveland Clinic. “These kinds of sessions have proven to be great crowd pleasers. They speak directly to the practicing healthcare provider about the things we see and do day in and day out as we take care of our patients.”

Topics during these sessions will include:

• De-escalating and stopping medical therapies.
• Advances in the prevention of the post-operative recurrence of Crohn’s disease.
• Sexual dysfunction and infertility challenges in IBD patients.
• Enteral nutrition in pediatrics.
• The biological experienced patient: When to restart the same biologic, when to switch biologics, and does insurance matter?
• Your IBD patient presents with a stoma problem: What do you do?
• Managing Crohn’s disease patients with intraabdominal complications.

“We will take a case-based, practical approach to the material and really engage the audience, which can be about 2,000 to 2,500 people,” says Dr. Regueiro. He and Cory Siegel, MD, of Dartmouth, will moderate the first session. “People ask lots of questions. We come together as a group and participants learn practical approaches that they can take away,” he says.

Sunanda (Susie) Kane, MD, from Mayo Clinic and Stephen Hanauer, MD, from Northwestern University will moderate the other clinical case session. Dr. Hanauer is also a co-chair of the AIBD conference.

Not dodging tough questions

Clinicians sometimes face difficult, confusing issues around the safe use of biologic treatments for IBD. These issues will provide the focus of Dr. Regueiro’s keynote address.

The keynote will put into a helpful, actionable perspective some of the most difficult questions with which clinicians treating IBD struggle. Keynote topics include:

• Monitoring patients on new therapies, and ways to improve the safety of these new therapies.
• What to do when adverse events occur. In this realm, Dr. Regueiro will offer “less evidence and more eminence.” That is, he will talk about his actual experiences with patients, rather than only presenting research findings and leaving it to listeners to decide how they would react in a similar situation. He will offer expert guidance based on the data.
• Guidance on specific side effects which may justify discontinuation of a new treatment. Guidance on times they do not justify discontinuation, and what to do instead.
• An adverse events checklist.
• Dealing with infections, malignancies, dermatologic problems, etc.
• Clearance of biologic treatments: If you do stop them, how long does complete clearance take?
• A “safety pyramid:” “Treatment must be individualized, accounting for benefits and risks,” the pyramid states, “Active IBD is an adverse event. If [your patient is] not responding to that medicine, optimize treatment or switch!”

Counterbalancing commercials

In recent years, IBD treatment has evolved to involve earlier use of biologic therapy in patients with Crohn’s and ulcerative colitis. These highly effective medications can change the natural course of these illnesses, and for many patients they represent a major advance over treatment options of years past.

“Twenty years ago, we used to only have prednisone and anti-inflammatories. High numbers of patients were admitted to the hospital and had to have surgery,” Dr Regueiro says. Patients often found themselves going in and out of the hospital.

“Now with this highly effective therapy starting early we can actually return people to complete remission and normal lives,” he says. However, biologics do involve very rare, but significant safety issues.

Commercials for these drugs simultaneously entice and alarm patients. “They understand that there are effective treatments but they are sometimes terrified by the potential side effects,” says Dr. Regueiro. Furthermore, he says, many healthcare providers who treat IBD are also scared of these new therapies.

“The keynote really gets at the root of grounding the side effects in [the big picture about] these treatments; really weighing the risks and benefit,” says Dr. Regueiro.

A fast growing event

About 120 attendees joined in the first AIBD conference, held in 2002. By 2017, the meeting had grown to attract 2,000 participants. This year, registration has reached about 2,500.

“It’s the largest IBD conference in North America,” says Dr. Regueiro, who adds that year by year, AIBD has also been growing increasingly international.