Alain Bitton, MD

27 Pages·2016·1.1 MB·English

Crohn’s Disease
Alain Bitton, MD
#CAREDDW
Disclosures
• Advisory Boards : Abbvie, Janssen,
Ferring, Takeda, Actavis, Shire, Merck,
Pfizer
• Educational activities/speaker: Abbvie,
Janssen, Takeda, Shire
• Research: Abbvie
Crohn’s Disease DDW 2016
• Epidemiology
• Monitoring Disease Activity
• Thiopurines
• Optimization of anti-TNF
• Biosimilar infliximab
• Novel Therapeutic agents
Epidemiology
Surgical Resection Rates for Crohn's Disease A
Population-Based Time Trend Analysis
• Population-based, 2002- 2011 Calgary Health Zone
• Discharge Database, (≥18 years). Surgical intestinal resection (n=980)
• The decrease in surgical rates mainly elderly patients ≥65 years (APC=-12.3%;
95% CI: -19.6, -4.4) and in patients undergoing partial colonic resections (APC=-
8.5%; 95% CI: -13.2, -3.5)
Monitoring Disease Activity
Monocytosis a Biomarker in IBD
• Monocytes and Macrophages play important role in the pathogenesis of IBD
• Prospective IBD registry –
• Assessing outcomes in IBD patients with monocytosis
• Monocytosis : A marker of more severe disease in IBD ?
165: Cherfane
Fecal Calprotectin and Fecal
Immunochemical Testing
• Evaluate the accuracy of FCP and quantitative FIT for stool hemoglobin
to predict endoscopic MH
• 80 pts colonoscopy (40 CD,40 UC). FIT and FCP done 48 hrs before
• FCP <150ug/g sensitivity of 0.97 for detection of MH and an area under
the curve (AUC) of 0.75 [95% CI: 0.63–0.86].
• FIT <50ng/mL was less sensitive (0.70) but more specific for MH (AUC
0.79 [95% CI: 0.69–0.90]).
• Combined FCP+FIT (<375) had a
sensitivity of 0.80 and specificity of 0.69
for MH
Su1800:Ma
iphone App – Fecal Calprotectin
• QuantOn Cal – stool extraction device + immunochromatographic rapid test
performed by iphone App via camera
• Results sent to webserver
• Monitored, reviewed by MD or IBD Nurse
• Assessment QuantOn Cal vs Elisa, 150 IBD,IBS patients
• QuantOn Cal produces quantitative test 25-2000 mg/g stool
• Total agreement 94.6%
1073: Wintgens
Thiopurines