DDW Highlights: Managing Today's GI Patient

Program Overview

Inflammatory bowel disease (IBD) is the term used to describe two chronic diseases that cause inflammation of the GI tract: Crohn’s disease (CD) and ulcerative colitis (UC). Although these two diseases have many common features, there are important differences between the two conditions. UC is an inflammatory disease of the colon resulting in inflammation and ulceration of the intestinal mucosa. In contrast, CD can affect any part of the GI tract and results in inflammation that extends much deeper into the layers of the intestinal wall.¹

IBD is complex, which is reflected in the wide variation in clinical practice in terms of diagnosis and management.^2,3 The management of IBD involves a continuum of drug therapy and surgical treatment, each with distinct risks, benefits, and side effects.⁴ The emergence of biologic therapy in recent years has dramatically changed expectations with respect to patient outcome and quality of life in IBD. These agents bring new challenges to physicians such as: decisions about the optimal time to initiate therapy with biologics; the need to monitor for increased risk of malignancy and infection; the development of antibodies and subsequent tolerance.^5-7 Drug therapy for IBD is a rapidly evolving field with many new biologic agents under investigation, such as the TNF alpha inhibitors, natalizumab, and the IL12/23 inhibitors and physicians need to be aware of emerging data for these investigational agents.⁸ There are also areas of controversy and debate with the pharmacologic treatment of IBD such as the benefits of “top-down therapy” (i.e. early aggressive therapy with immunomodulating therapies) versus the traditional “step up” approach to therapy in CD.⁹ Another area of debate is the role in therapy of combination treatment with thiopurines or methotrexate, and biologics.⁹

Given the significant health and economic burden of IBD, it is vital that physicians are equipped with the necessary knowledge and skills to optimize the management of patients with UC and CD.  This activity will provide a review of the data presented at the 2011 meeting of DDW, providing an optimal method for conveying new developments in the treatment of IBD to practitioners through an expert review of the information.

1. Loftus EV Jr.  Management of extraintestinal manifestations and other complications of inflammatory bowel disease.  Curr Gastroenterol Rep. 2004;6:506-513.
2. Altschuler A, Collins B, Lewis J.  Gastroenterologists’ attitudes and self reported practices regarding inflammatory bowel disease.  Inflamm Bowel Dis. 2008;14:992 999.
3. Carter MJ, Lobo AJ, Travis SPL.  Guidelines for the management of inflammatory bowel disease in adults.  Gut. 2004;53:1 16.
4. Lashner B.  Ulcerative colitis: clinical advances. Available at http://cme.medscape.com/viewarticle/444509.  Accessed November 10, 2009.  
5. Baert F, Noman M, Vermeire S, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn's disease. N Engl J Med. 2003;348:601-608.
6. Farrell RJ, Alsahli M, Jeen YT, Falchuk KR, Peppercorn MA, Michetti P. Intravenous hydrocortisone premedication reduces antibodies to infliximab in Crohn's disease: a randomized controlled trial. Gastroenterology. 2003;124:917-924.
7. Rutgeerts P, Feagan BG, Lichtenstein GR, et al. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn's disease. Gastroenterology. 2004;126:402-413.
8. Podolsky DK.  Beyond tumor necrosis factor: next generation biologic therapy for inflammatory bowel disease.  Dig Dis. 2009;27:366-369.
9. Lichtenstein G, Hanauer S, Sandborn W, et al.  Management of Crohn’s disease in adults.  Am J Gastroenterol. 2009;104:465 483.  

Intended Audience
This educational activity is intended for clinical gastroenterologists in academia, private and community practice, gastroenterology trainees, and other GI healthcare providers interested or involved in the treatment of patients with inflammatory bowel disorder.

Format: Online Webcast
Duration: 1 hour

Activity Director
David Rubin, MD, AGAF
Associate Professor of Medicine
Co-Director, Inflammatory Bowel Disease Center
University of Chicago Medical Center
Chicago, IL

Faculty
Russell D. Cohen, MD, AGAF
Associate Professor of Medicine
Co-Director, Inflammatory Bowel Disease Center
University of Chicago Medical Center
Chicago, IL

Barbara S. Kirschner, MD
Professor of Pediatrics
Inflammatory Bowel Disease Center
University of Chicago Medical Center
Chicago, IL

Editor
James A. Shiffer, RPh, CCP
Content Manager
MedEd Architects , LLC
Chicago, IL

Content Independence
This CME activity is funded through educational grants from Abbott Laboratories, Inc., and UCB, Inc.  The content was developed independently by the contributing faculty or editor and has undergone peer review by the activity director or editor. All materials appear with permission of the author(s). The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.

Policy Disclosure
In accordance with AGA Institute policies, be advised that one or more presentations in this CME activity might contain references to off-label or unapproved uses of drugs or devices. The use of these agents outside currently approved labeling is considered experimental, and the manufacturers' prescribing information for these products should be consulted.
 
This CME activity was planned and produced in accordance with Accreditation Council for Continuing Medical Education (ACCME) Essential Areas and Policies

Disclosures
In accordance with the ACCME's Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.

• David T. Rubin, MD, AGAF
  Abbott Laboratories, Inc; Cornerstones Health, Inc; Centocor Ortho Biotech, Inc; Elan Pharmaceuticals; Millennium Pharmaceuticals; Optimer Pharmaceuticals; Procter and Gamble Pharmaceuticals; Takeda Pharmaceutical Company Limited; UCB, Inc.; Given Imaging; Optimer Pharmaceuticals; Elan Pharmaceuticals; Prometheus Laboratories, Inc; Salix Pharmaceuticals; Cornerstones Health, Inc; Schering Plough Canada, Inc.
• Russell D. Cohen, MD, AGAF
  Abbott; Advogent Group; Axcan, Scandipharm; Centocor Ortho Biotech, Inc; Elan Pharmaceuticals; Guidepoint Global Consulting; Merck Sharp and Dohme Farmaceutica/Merck, Brazil; Millennium Pharmaceuticals/Take; Prometheus Laboratories; Salix Pharmaceuticals; Sanofi-Aventis; Schering-Plough/Merck, Mexico; Shire Pharmaceuticals; Tactical Advantage Group; Warner-Chilcott.
• Barbara S. Kirschner, MD
  Abbott; Centocor Ortho Biotech, Inc; UCB, Inc.

Editor
James Shiffer, RPh, CCP
There are no relevant financial relationships to disclose.