Faculty Disclosure

1
Faculty Disclosure
Maria Abreu
Discloses the following relationship(s)
Abbott Self Consulting fee Consulting Berlex
Laboratories Self Consulting fee Consulting
Elan Pharmaceuticals Self Consulting fee
Consulting Procter Gamble Pharmaceuticals
Self Consulting fee Consulting Prometheus
Laboratories Self Consulting fee Consulting
UCB Pharma Self Consulting fee Consulting
Procter Gamble Pharmaceuticals Other
financial benefit Grant/Research Support
Abbott Other financial benefit Speaking and
Teaching Salix Pharmaceuticals Other financial
benefit Speaking and Teaching Procter Gamble
Pharmaceuticals Other financial benefit
Speaking and Teaching Prometheus Laboratories
Other financial benefit Speaking and Teaching
2
Case

• A 40 year old man with perianal fistulae and
  abscesses
• The pt has ileal disease initially managed with
  5-ASA
• He continues to have abdominal pain then develops
  a new perianal fistula
• He sees a general surgeon who says CD fistulas
  cannot be treated surgically
• He starts on 6-MP
• After 6 months of 50mg/day, he has no response
• What do you do next?

3
Case (cont)

• Does he need additional imaging tests?
• Should he have used biologics earlier?
• What are the appropriate surgical techniques that
  can be used?
• Are there additional targets of cytokine-based
  therapy that may be an option in the future?

4
Summary of IBD sessionor at least my take on it!
5
Summary of Scott Plevys talk

• There are many new targets for cytokine or
  chemokine-directed biologics
• These include
• IL-17
• IL-23
• We need better ways to predict who will respond
  to different therapies
• Genetic tests
• Bacterial profiling

6
Summary of Asher Kornbluth

• CTE and WCE are both very sensitive
• Be careful not to over-interpret WCE
• Serologies can be used in a select group of pts
  esp in indeterminate colitis
• Better for predicting disease phenotype in CD
• MRI is coming and less risk of radiation exposure

7
Summary of Bill Sandborn

• We should learn from rheumatology
• Current treatment paradigms still result in need
  for surgery
• Data support early therapy to prevent need for
  steroids but unclear if will change need for
  surgery and long-term outcomes
• Combination therapy associated with increased
  risk for infectionsreserve for more agggressive
  disease

8
Summary of John Rombeau

• Surgery (surgeons) are not the enemy
• Well-timed surgery relieves symptoms and leads to
  long remissions in many pts
• J-pouch for CD can occasionally be performed with
  good outcomes, esp in pts without perianal
  disease
• Important to send pts with perianal fistulas to
  colorectal surgeon for setons or abscess
  drainagewe need combined approaches!

9
Summary of David Rubins talk

• Inflammation is a risk factor for CAC
• 5-ASAs have a modest protective effect
• Surveillance continues to be important but we
  need to incorporate targeted approaches
• Chromoendoscopy
• NBI