What advice do you have for young women?

“Cultivate resilience and empathy! Medical professions can be challenging both emotionally and physically. Cultivate resilience to overcome obstacles and setbacks along the way.” - Naglaa Abdellatif, MD

#IBDHorizons24 Recap
🤝Multi-d + IBD-CRS expert
👨🏽‍🦳Every pt differs - individualize
💊LoR is common - Proactive monitoring
🌀IUS valuable with multi other tools
🥊Fight insurance
👩🏻‍🦰Women have specific dz needs
🔦Cancer risk is IBD care & new tools for managing
🔮New therapy class…

We proudly present our new Center for Advanced Inflammatory Bowel Disease Care, offering a wide range of IBD treatments.

“From the first step inside the center, patients become family.” - Dr Feza Remzi

More on how this will revolutionize IBD treatment ➡️ northwell.edu/news/the-lates…

IBD Horizons The Oregon Clinic Dr Feza Remzi Bincy Abraham, MD, MS Anita Afzali MD, MPH, MHCM, FACG, AGAF Michael Chiorean Ghassan Wahbeh, MD Scott D Lee, MD Flavio G Rocha, MD, FACS, FSSO Jennifer Fijor OHSU News OregonACP What an amazing and fun day of learning! Can’t wait until next year!

#IBD Horizons24 Feagan

🚨NEW CLASS of #IBD therapies🚨
TL1A
mod to severe #UlcerativeColitis
🆕TNFa antagonist naive
❌didn't respond/tolerate other (AZA, 6-MP, cortico)
🛑stop IMM
👺Cortico up to 20 mg/d of pred or equal w tapering from 6wk

#IBD Horizons24 #BrianFeagan

Research in #IBD :
VDZ works well for pouchitis
UPA for #UlcerativeColitis
Risa for #Crohns
Combo is the way to go, no monotherapy for UC
IL23’s likely more effective than the others

#IBDHorizons24 Bincy Abraham, MD, MS

Case:

Surveillance Chromo-endoscopy

59yo with #Crohns colitis for >20 years
🔦sigmoid flat 1.5cm lesion with low grade dysplasia
🔦Remainder was normal

🤔What would be the next steps in management you'd discuss with the patient?
Dr Feza Remzi

#IBDHorizons24 Bincy Abraham, MD, MS
How would you answer this Q?

Which is FALSE:
A) Most dysplastic lesions are endo visible
B) Screening for SB cancer is indicated annually with ileal #Crohns
C) Dz duration, extent, & activity are a/w dysplasia risk
D) PSC a/w⬆️dysplasia risk…

#IBDHorizons24 Elisa Boden, MD

How would you answer this #WomensHealth Q?

Which is FALSE:
A. Flex sigmoid w/o sedation safe during🤰
B. Active dz a/w ⬆️risk of🤰complications
C. All advanced tx is contraindicated during🤰
D. Thiopurines a/w ⬆️ risk of cervical dysplasia

#IBD Horizons24 Elisa Boden, MD

#WomensHealth
🧬Pts overestimate #IBD risk in offspring - many choose childless
Vaginal delivery👍GI bacterial colonization
Breastfeeding may ⬇️offspring's risk

📆Trimester visits
🩸lab monitoring (CRP, calprotectin)
💊meds continuation advised

#IBDHorizons24 Elisa Boden, MD

#WomensHealth

Manage pregnancy flares aggressively
✨NEW info: baby Aspirin *may* prevent preeclampsia; rec by ACOG & NICE at 12wks
Early-onset pre-eclampsia⬆️complications
🤝MFM + GI

MDT team (GI, PCP, OB/gyn, Surgeon, Psych, PT, Derm)

#IBDHorizons24 Monitoring Panel
Antibodies matter other than TNF's?
BF: depending but no
All panel: no

Inflammation monitoring choice?
Elisa Boden, MD: Enterography
Ghassan Wahbeh, MD: endo & image
JJ: no great way to assess
BF: depends

Retained VCE med emergency?
All panel NO‼️

Ralley Prentice Bincy Abraham, MD, MS IBD Horizons Maia Kayal MD Britt Christensen, MBBS MPH PhD Jill Gaidos, MD Marita Kametas Madhuri Badrinath Catherine Bonnar Jessica Philpott PIANO True but,,, also true that the greatest pregnancy risk is uncontrolled disease, which is > than any medication (except Mtx). I am comfortable extrapolating from other IgG1 mAbs or USTK as far as the safety of Risa. I lose a lot more sleep over flares during 🤰. Need for speed

Michael Chiorean Bincy Abraham, MD, MS IBD Horizons Maia Kayal MD Britt Christensen, MBBS MPH PhD Jill Gaidos, MD Marita Kametas Madhuri Badrinath Catherine Bonnar Jessica Philpott Michael Chiorean very reasonable if not 🤰, however IL-23 safety data in🤰not there yet and steroids associated with ⬆️ adverse neonatal outcomes (again from PIANO), which is while I’d try EEN + direct to anti-TNF without steroid if pt can tolerate gut.bmj.com/content/71/9/1…

That's also an option. I tend to maximize current therapy before moving on. If levels of UST was low I would reinduce if possible too. But if great levels I would switch mechanism of action

#IBDHorizons24 #MitraBarahimi
How would you answer this Q?

Which is TRUE?
A)Emerg IBD surg same post op complication risk as elective
B)Thiopurines NOT a/w post-op adverse outcomes
C)VDZ & UST⬆️risk of post-op infx
D)IV anti-TNF more likely affect wound healing than subq…

#IBDHorizons24 Dr Feza Remzi

How would you answer this Q?

Which is FALSE regarding #Jpouch #IPAA expectations:
A. Pts have ~4-5 bm at night
B. >50% of pts have no urgency
C. Majority of pts happy with surg
D. Majority of pts have full continence

#IBD Horizons24 Dr Feza Remzi

#IBD surgery is a lifelong relationship between the CRS & patient‼️

Some pts would rather have ileo than #jpouch
👂Listen to the pt in front of you, don't instill bias
🖐️Digital exam very important part of surgical procedure

Learning on a Saturday is always more fun with conferences like @ibdhorizons_

Attending the 1st Annual IBDHorizons City of Roses PDX Symposium

New location, different voices, and networking opportunities to stay on top of #ibd #GItwitter

Oh, did I mention it’s free?

#IBD Horizons24 Fausel

Loss of Response - What does it mean in #IBD & what next?

To consider when checking LOR:
⏲️Timing - post induction
🩺comborbidities - DVT, CHF, Age, EIM
🔥Activity & severity
🔦Involvement
🧬Phenotype
⬆️dose
💊Switch class