Day 1 :
Keynote Forum
Quintin H González
University of Alabama, USA
Keynote: Primary fistulotomy and surgical drainage abscess is associated with low fistula recurrence rate
Time : 10:05-10:45
Biography:
Q H González was Graduated MD by the Autonomous University of the State of Mexico (UAEM) and got his best average distinguished with the prize Up John to the academic excellence and the medal Ignacio Ramirez. He did his post-graduation in General Surgery in the National Institute of Nutrition Salvador Zubirán, distinguished as chief residents. He is a Sub specialist in Colorectal and advanced laparoscopic surgery in The University of Alabama At Birmingham, USA, distinguished as outstanding international school, certified by the Mexican boards in General Surgery, gastrointestinal surgery and the Mexican Board of specialists in diseases of the colon, rectum and anus. He is the past president of Mexican collage of coloproctology, distinguished as Doctor Honoris Causa in health at Perú in 2013. He is a member of Mexican Academy of surgery and national Academy Medicine and American Society of colon and rectal surgery, author of 70 articles published in indexed journals more than 300 conferences by invitations, 43 abstracts and 36 posters.
Abstract:
Background: Most of the anorectal abscess has a cryptogladular origin different forms of treatment as antibiotics, needle aspiration or drainage with local anesthesia are associated with high rate of recurrence and development of fistula. There are few literatures regarding the one stage management performing drainage with identification of primary hole and fistulotomy. Aim: To analyze a retrospective series of 90 cases of anorectal abscess in terms of surgical outcomes with focus in recurrence and development of fistula tract. Material and Methods: During the period June 2011 to April 2015 a total 90 patients were included, they had an average age of 39 years old (range 19-73 ), according with the location were 49% isquiorectal , posterior 29%, anterior 19% and horseshoe 3%, with predominance of male n=67 (77%), patients were treated in several private tertiary care hospital HMG Coyoacan predominantly (48.1), time operative, bleeding, time of healing, recurrence, age and sex was analyzed. Results: The mean age was 39 years old (range 19-73 ) with a predominance of male sex (77%), mean of surgical bleeding was 15ml, hospital stay of 1 day (100%), operative time 19.8minutes (range 15-20), time of recovery was 14 days and time of healing 20 days, recurrence 2.5% (2 patients), requiring a new fistulotomy , the pain was controlled with paracetamol 750 mg three times a day alternating with ketorolac 10 mg three times a day orally and antibiotic amoxacilin-clavulanic acid 875 md twice/day during 10 days. Conclusions: This study shows that performing both procedures drainage and fistulotomy the incidence of fistula is very low, therefore we recommend in abscess with cryptoglandular origin; this approach which potentially decrease another surgery in the future.
Keynote Forum
Fratila Ovidiu
University of Oradea, Romania
Keynote: The assessment of Tuberculosis risk in patients with inflammatory bowel disease and biological therapy
Time : 11:15-11:55
Biography:
Fratila Ovidiu completed his MD and PhD at “Iuliu Hatieganu†University of Medicine from Cluj-Napoca Romania. He is an Associate Professor at University of Oradea and Head of the Internal Medicine Department from Emergency Clinical County Hospital from Oradea. He has published many papers in well known journals and also several books in the field of Internal Medicine and Gastroenterology. He has participated actively in many renowned international conferences and congresses. He is also involved in conducting clinical trials especially concerning inflammatory bowel disease. He is a member in many European profile societies like European Society of Gastrointestinal Endoscopy, European Association for the Study of the Liver, European Society of Digestive Oncology, European Society of Digestive Oncology, European Crohn’s and Colitis Organisation. Currently, he is also a distinguished member of the Russian Academy of Natural Sciences.
Abstract:
Tuberculosis remains major health problem worldwide, with the emergence of multidrug-resistant (MDR-TB) or highly resistant (XDR-TB) Mycobacterium tuberculosis. Also, it is estimated that one third of the world population has latent TB infection. Patients with Crohn\\\'s disease and Ulcerative Colitis that are treated with anti TNF-alfa agents, have a 14 times higher risk of reactivation of latent TB than healthy subjects. Latent TB reactivation occurs mostly during the first year of anti TNF treatment, with a short median reactivation time to infliximab (3-6 months), compared with adalimumab (8-16 months). When TB occurs in patients receiving anti-TNF, it is usually atypical (extrapulmonary in 50%, disseminated in 25% of cases), making diagnosis more difficult. This is particularly important because the mortality in TB patients during the anti-TNF therapy has been reported to reach up to 13%. To reduce this risk we have three means at hand: screening is the most important mean, second is chimioprophylaxis and the third is careful monitoring of the patient. Therefore several key issues regarding current guidelines in the assessment of tuberculosis risk and its management will be discussed during this presentation. As a conclusion we can emphasize that the emergence of anti-TNF alpha therapy has provided a new therapeutic approach that is often \\\"dramatically\\\" efficient, but which also brought new concerns regarding security, its use being accompanied by the risk of reactivation of latent TB infection. Screening can reduce these risks but it cannot eliminate it completely which is why monitoring for latent TB reactivation in patients with anti-TNF therapy must be extremely vigilant.
Keynote Forum
Debby Laukens
Ghent University, Belgium
Keynote: Targeting the development of intestinal fibrosis in Crohn’s disease
Time : 14:00-14:25
Biography:
Debby Laukens graduated as a biochemist from the University of Antwerp (Belgium) and obtained a PhD degree at Ghent University (Belgium) on “Transcriptome Profiling and Genetic Analysis to Identify Susceptibility Genes for Crohn’s Diseaseâ€. She completed Postdoctoral studies at theUniversity Hospital in Ghent and today, she is group leader of the IBD research unit at the department of Gastroenterology, which focusses on pre-clinical research related to inflammatory bowel diseases. She has published more than 50 papers in reputed journals in the field of gastroenterology.
Abstract:
Intestinal fibrosis is a common complication of Crohn’s disease. Fibrotic strictures are the most important indication for surgery and current therapies do not prevent their development. Due to the lack of anti-fibrotic therapeutic options, patients with a fibrostenosing phenotype (roughly 30% of cases) will progressively develop narrowing of the intestinal lumen, leading toclinically overt obstruction over time. Crohn’s-associated remodeling of the intestinal bowel wall is a complex cascade that is initiated by epithelial damage and activation of innate and adaptive effector cells, which trigger the recruitment and activation of fibroblasts that reorganize the extracellular matrix. The chronic nature of inflammation ensures sustained fibroblast activation, and together with reduced sensitivity of this fibroblast to apoptosis and their further induction by mechano transduction, this process results in disorganized, excessive extracellular matrix deposition, and finally stiffness of the bowel wall. We recently provided promising pre-clinical evidence that the inhibition of Rho kinase (ROCK), a key mediator in TGFß-induced activation of fibroblasts, harbors potent anti-fibrotic action. In spontaneous hypertensive rats, soft ROCK inhibition induced no cardiovascular effects at 10 mg/kg p.o, and daily treatment of mice did not induce toxicity. In the chronic DSS-induced model of colitis, as well as in the adoptive T cell transfer model, intestinal fibrosis develops only marginally in treated mice, which is associated with reduced colonic protein levels of pro-fibrotic cytokines IL6, IL13 and TGFï¢1-2, andattenuated production of matrix metalloproteinases 2, 3 and 9. Both in vivo and in vitro data show decreased activation of colonic fibroblasts in the presence of ROCK inhibitors, whereas manifest autophagy is induced. Finally, we observe little or no effect of ROCK inhibition on inflammatory markers/cell activation, suggesting direct anti-fibrotic action and its use as an add-on therapy for patients who are at risk to develop stenosis.
Keynote Forum
Ragaey Ahmad
Beni-suef University, Egypt
Keynote: Prevalence of Microscopic colitis in patients with Diarrhea-predominant Irritable bowel syndrome
Time : 14:25-14:50
Biography:
Ragaey Ahmad Eid had completed his MBBCH at Beni-suef faculty of medicine in 2006. He was a Resident of Hepatogastroentrrology unit from 2008-2010. He did his Master degree on Hepatogastroenterology in 2011. He is now working as Assistant Lecturer fom 2011 to till now in the same faculty. Now he is a junior researcher studying for his MD.
Abstract:
Background: Irritable bowel syndrome (IBS) is one of the mostcommon functional gastrointestinal disorders. Properly diagnosing IBS can be challenging and uncertain as there is no clinical, biological orendoscopic marker for IBS. One gastrointestinal disorder frequently misdiagnosed as irritable bowel syndrome is microscopic colitis (MC). Thus, differentiating patients with diarrhea predominant IBS from those with microscopic colitis can be challenging as MC and IBS-D have similar symptoms.\\\\\\\\r\\\\\\\\n\\\\\\\\r\\\\\\\\nObjective: Our study is aiming to estimate the prevalence of microscopic colitis in patients diagnosed with diarrhea predominant-IBS according to Rome III criteria.\\\\\\\\r\\\\\\\\n\\\\\\\\r\\\\\\\\nMethods: Our study was designed in Beni-Suef university hospital in the period between February 2013 to December 2014. Patient was diagnosed as IBS according to the Rome III criteria. All patients were undergone fullhistory taking, clinical examination, laboratory investigations, abdomino pelvic ultrasonography, upper GIT endoscopy & colonoscopy with multiple biopsies for histopathological examination.\\\\\\\\r\\\\\\\\n\\\\\\\\r\\\\\\\\nResults: The prevalence of MC was 21% (15/120 CC & 11/120 LC).Duration of diarrhea was significantly higher in MC patients. MC was significantly associated with certain drugs and concomitant diseases.\\\\\\\\\\\\\\\\r\\\\\\\\\\\\\\\\n\\\\\\\\\\\\\\\\r\\\\\\\\\\\\\\\\nConclusion: Rome III criteria is not sufficient for exclusion of MC. Total colonoscopy with multiple biopsies from normal appearing mucosa is recommended for every patient previously thought to have IBS-D to exclude MC.
Keynote Forum
Lu Liu
University of New South Wales, Australia
Keynote: Current advances in inflammatory bowel disease research
Time : 11:55-12:20
Biography:
Lu Liu completed her PhD in Monash University, Australia in 1998, and received the prestigious Mollie Holman Medal for best PhD thesis. From 1998-2005, she worked as a Post-doctoral research officer and senior research fellow in the gastrointestinal pharmacology research field at UNSW Australia. In 2006, she took up an academic position, became a Lecturer in the same institution and was promoted to Senior Lecturer in 2009. As a Chief Investigator, she has obtained research funding over $2.5 million from various grant bodies to support her research. She has established a track record of quality research outputs. She has published over 50 original research papers in high impact pharmacology, gastroenterology and urology journals and over 130 conference abstracts. Her research has been recognized both nationally and internationally. She received many awards and has been frequently invited to present at the conference symposia and seminars.
Abstract:
Inflammatory bowel disease (IBD) is a chronic and debilitating gastrointestinal disorder, characterized by excessive inflammation within the gut wall with severe sequelae. In the majority of cases the etiologies of IBD are unknown, and conventional therapies have not been sufficiently effective. In order to improve health-related quality of life and well-being of patients, it is necessary to develop further therapeutic options. In addition to act as an energy source within cells, the purine nucleotide ATP can also be released from cells and functions as an autocrine/paracrine signal, modulating a broad range of cell and organ functions and contributing to disease processes, e.g. inflammation, through activation of purinergic P2X and P2Y receptors. The mechanisms responsible for ATP release have remained unresolved, although considerable evidence suggests that pannexin and connexin channels are ATP permeable conduits for the release of intracellular ATP into the extracellular space. Our new data have shown that pannexin and connexin channels are localised to intestinal epithelial cells and lamina propria immune cells, and mediate stretch- and/or Ca2+-dependent ATP release from human colonic mucosa and epithelial cell lines. We found that the purinergic P2X7 receptor, a key player in proinflammatory interleukin (IL)-1β processing and release, had a similar expression profile, suggesting that ATP released from these channels may act as an autocrine or paracrine molecule to activate P2X7 receptor, and thereby be a key factor underlying inflammatory responses. We also found that the P2X7 antagonist and pannexin-1 channel inhibitor could block TNFα and IL-1β induced reduction in transepithelial electrical resistance. These new findings provide a potential avenue for the development of novel therapeutics that targets P2X7 receptor and ATP release channels.
Keynote Forum
Konstantinos Papamichail
KU Leuven, Belgium
Keynote: Withdrawal of Anti-TNFα therapy in Inflammatory bowel disease: Is it feasible?
Time : 14:50-15:15
Biography:
Konstantinos Papamichail completed his MD, PhD and Post-doctoral studies (Department of Pharmacology) from Medical School, University of Athens, Greece and is a Fellow of the European Board of Gastroenterology and Hepatology. He is currently a Postdoctoral researcher in the Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID), IBD group, KU Leuven, Belgium. He has received many honor and awards and his work was presented in many national and international conferences and published in numerous high impact factor journals. His research interests are inflammatory bowel disease, anti-TNF therapy, therapeutic drug monitoring.
Abstract:
Anti-tumour necrosis factor alpha (anti-TNFα) therapy is an established treatment in inflammatory bowel disease (IBD) namely Crohn’s disease (CD) and ulcerative colitis (UC). However, this treatment is associated with high costs and the possibility of severe adverse events representing a true challenge for patients, clinicians and health care systems. Consequently, a crucial question is raised namely if therapy can be stopped once remission is achieved and if so, how and in whom. Additionally, in a real-life clinical setting, discontinuation may also be considered for other reasons such as the patient’s preference, pregnancy, social reasons as moving to countries or continents with less access, or different local policy or reimbursement. In contrast to initiation of anti-TNFα therapy guidelines regarding stopping of this treatment are missing as supporting data is lacking. There is even less information regarding prognostic factors that could predict relapse or sustained remission after anti-TNFα therapy discontinuation. The only provided evidence regarding CD comes from the landmark STORI trial and a few retrospective observational or small prospective studies, while for UC there are even less data available. As a result, the decision of discontinuation is still a challenging aspect in the use of anti-TNFα therapy. Currently this is typically based on an estimated, case-by-case, benefit-risk ratio as the optimal withdrawal strategy is still debated. Another important issue when considering cessation of anti-TNFα therapy is whether the drug can safely be restarted when needed and whether efficacy will be similar. Possible lower response rates after re-initiation of biological therapy, limited alternative treatment options and/or immunogenicity concerns are all factors which constitute to the fear of stopping treatment.
Keynote Forum
Maria Gazouli
University of Athens, Greece
Keynote: Targeted therapeutic potential of the human mesenchymal stem cells in the Inflammatory bowel diseases
Time : 15:35-16:00
Biography:
Maria Gazouli completed her BSc and PhD from Biology Department and School of Medicine in Athens, Greece and Postdoctoral studies from Georgetown University Medical Center Washington DC, USA. She has received many honor and awards. She is an Assistant Professor of Molecular Biology at School of Medicine University of Athens, Greece. She has published up to 181 papers in high IF Scientific Journals.
Abstract:
Inflammatory bowel diseases (IBD), including Crohn\\\\\\\\\\\\\\\'s disease and ulcerative colitis, are chronic inflammatory diseases with a significant increase in cases in recent years. The exact etiology of IBD remains unknown, while a large number of factors such as environmental effect, immune response, and genetic predisposition are thought to contribute to the pathogenesis of the disease. Genetics cannot explain the increasing incidence of inflammatory bowel disease in specific geographic areas so it needs also the impact of various factors such as viruses or bacteria, smoking, taking antirheumatic drugs, the addition of preservatives in foods, a change in the dietary habits, and probably stress. The usual therapeutic practice is the use of immunosuppressive and anti-inflammatory agents and finally the use of biological agents such as anti-TNF. Despite the systematic therapeutic approach and the use of new biological agents, the need for surgery has remained stable. As more effective treatments that target immediately the affected area are searched, human stem cells (hMSCs) are tested for the treatment of inflammatory diseases such as IBD, rheumatoid arthritis, type I diabetes and multiple sclerosis. Recent studies have shown that the mechanism of action of immunosuppressive properties of hMSCs is both direct by cell contact of hMSCs with the cells of the affected region, and indirect by the secretion of soluble molecules from hMSCs as TGF-b, prostaglandin E2, nitric oxide, etc. Furthermore, data suggest that the immunosuppressive effect of hMSC focuses in the area of inflammation and is regulated by cells and factors found in the microenvironment, supporting that the largest possible approach and injection of hMSCs near inflammation may increase the therapeutic effect.
Keynote Forum
Vahit Onur Gul
Edremit Military Hospital, Turkey
Keynote: Treatment of our case with rectal prolapsus and solitary rectal ulcer by Laparoscopic ripstein operation
Time : 16:00-16:25
Biography:
Vahit Onur Gul, MD, graduated from Gulhane Medical School in 1998, earned MD license, and in 2009, he finished residency in General Surgery (Department of General Surgery, Gulhane Medical School ). He is a General Surgeon at the Department of Surgery, Edremit Military Hospital. He took micro surgery courses at the University of Zurich in 2013. His research interests include Laparoscopic surgery, Metabolic disorders (obesity, liver steatosis, metabolic syndrome), Hepato-biliary pathophysiology and gallstone disease and laparoscopic treatment for benign esophageal disorders, abdominal wall hernias.
Abstract:
Purpose: Solitary rectal ulcer syndrom (SRUS) arises with one or more ulcers at rectum or with rectal wall thickening. It was defined in 1830 by Cruveilheir for the first time. It is met 1 over 100 000 in the society. SRUS generally shows up with rectal bleeding, pain, mucous defecation, difficulty in rectal evacuation. Rectal bleeding is the major symptom and occurs by 90 % of the patients. Since rectal prolapsus is present by patients with SRUS, in the studies performed it was shown that pelvic floor muscles were contracted discordantly and blood flow was decreased in the mucosa. One of our cases with rectal prolapsus and SRUS is presented in this presentation.\\r\\n\\r\\nCase: The patient was 45 years old and female and had the symptoms constipation, bleeding during defecation, tenesmus since two years. The patient had a medical history of idiopathic prolactinoma and hashimoto thyroiditis. The patient was anemic. In her gastroscopy, reflux esophagitis, hiatal hernia, helicobacter pylori (+) pangastritis were determined. In her colonoscopy, grade III hemorrhoidal disease, at upper rectum between 10-15 cm ulcer at rectum mucosa, dark coloured areas at cecum mucosa were determined. In the pathological examination, SRUS at rectum and melanosis coli at cecum were diagnosed. No pathology was observed in the enterography. External rectal prolapsus was determined in the digital defecography. Laparoscopic ripstein operation was applied to the patient. In the colonoscopy of the patient after one year, it was observed that SRUS at rectum was cured. \\r\\n\\r\\nConclusion: SRUS should be differentiated from other diseases causing mucosal ulceration. Medical or surgical treatment methods can be used according to the underlying cause. The priority in the treatment has the medical treatment. However surgical restoration could be prioritized by patients having coexisting rectal prolapsus.\\\\r\\\\n
Keynote Forum
Emidio Scarpellini
KU Leuven, Belgium
Keynote: Refractory GERD Treatment
Time : 16:25-16:50
Biography:
Emidio Scarpellini has got his MD degree in 2004 and the Internal Medicine specialization in 2009 at the Catholic University of Sacred Heart, Gemelli hospital in Rome. Since 2008 until 2009 he has been Rome foundation fellow at KU Leuven in the Neurogastroenterological and Motility lab directed by Prof. Jan Tack. Subsequently he has fulfilled two PhD programs: One successfully defended at the Catholic University of Sacred Heart, Gemelli hospital in 2013 and the other-one at KU Leuven, under the guide of Prof. J. Tack, successfully defended the 27th of February 2014. Since 2012 he is working as Assistant Professor at \\\"Sapienza\\\" University of Rome and currently working on hepatology in the Gastroenterological Unit directed by Prof. A. Attili. During this period he applied for several Universities, regional and national research grants, had been teaching to medical and nurse students, and examining them. He presented poster and oral, invited lectures at national, Belgian, European and international Internal Medicine and Gastroenterological meetings. He is author of several PubMed articles, with H-index of 18 and 1089 citations.
Abstract:
About 30-40 % of GERD patients fail to respond to conventional treatments (standard or double dose of proton-pump inhibitors (PPI), prokinetics, low dose antidepressants) and, despite the efforts of the pharmaceutical companies to rule out new drugs beneficially affecting reflux pathophysiology, their management give rise to a major medical problem. However, there are preclinical and preliminary clinical evidences on the usage of newer, both pharmacological and non-pharmacological, remedies in refractory GERD management. These remedies need an accurate updated reviewing work in order to give to the physician a clear snapshot of “where are we now†in GERD management (describing refractory GERD definition and differential diagnosis, and the issues arising from conventional therapies) and “what we will do†about the most promising treatments for refractory GERD. This last issue is crucial because will condition the attention of physician towards some of newer remedies for this subset of patients, in synergy with the pharmaceutical industry. T.A.R.G.I.D. is the largest gastrointestinal translational laboratory across Europe that is a world referral center for the study of gastrointestinal motility, in general and of the GERD pathophysiology and treatment, in particular. According to my previous PhD program experience in and the actual collaboration with TARGID I will talk about: GERD definition and its physiopathology, refractory GERD definition and its pathophysiology issues, diagnostic flow-chart (including definition of overlap diseases and refractory GERD misdiagnosis (e.g. functional dyspepsia)), evidence-based therapeutic flow-chart including both pharmacological (older and newer PPI types and dosage, prokinetics, drugs affecting lower esophageal sphincter functioning) and non-pharmacological treatments (laparoscopic, endoscopic antireflux surgery), newer development directions in refractory GERD management.
Keynote Forum
Nuno Vieira e Brito,
University of Porto, Portugal
Keynote: Steatosis in Crohn's disease patients. Role of surgical treatment
Time : 16:50-17:15
Biography:
Nuno Vaz Franco de Vieira e Brito has completed his Master’s Degree in Medicine at Porto University in 2015. He has already published one article in the Portuguese Allergology review and collaborated in other articles. He is currently undergoing admission for further specialization in the medical field as an intern.
Abstract:
Background: There is a known association between liver damage and inflammatory bowel disease (IBD), however non-alcoholic fatty liver disease (NAFLD) is not a frequent and well-studied complication in these patients. \\r\\n\\r\\nAim: This study aims to establish the prevalence of NAFLD in IBD patients and compare a population with and without NAFLD in order to characterize differences in the groups. \\r\\n\\r\\nMethods: A cohort of Crohn’s disease (CD) patients who underwent abdominal ultrasound imaging was selected and CD patients diagnosed with NAFLD on ultrasound (US) were compared to those without NAFLD in a case-control study.\\r\\n\\r\\nResults: From a population of 1059 patients, 313 (those with a valid abdominal US) were included for further analysis. Among these, 93 had signs of liver steatosis on US giving a prevalence of 29,7%. A ratio of 1:1 was used to conduct further statistical analysis. The mean age of patients with NAFLD was higher (39 years±11vs 45years±12; p<0,01) as well as the mean age at diagnosis (27years±11 vs. 32years±12; p=0,08). NAFLD patients had a worse lipidic profile (higher triglycerides and lower HDL) than controls as well as a higher liver enzyme level (AST, ALT, GGT). This study found no significant association with drug therapy (azathioprine, corticosteroids and anti-TNF) and NAFLD, however there was an association found regarding previous surgical procedures.\\r\\n\\r\\nConclusion: The changes caused by surgical procedures seem to be the most important factor in the development of NAFLD in CD patients, possibly due to alterations in microbioma. \\\\r\\\\n
Keynote Forum
Ines A. Trindade
University of Coimbra, Portugal
Keynote: The influence of maladaptive psychological processes on inflammatory bowel disease
Time : 17:15-17:40
Biography:
Inês A. Trindade is a Clinical Psychologist from Coimbra, Portugal. She has completed her MSc in Clinical and Health Psychology from the University of Coimbra at the age of 22, and is currently conducting her PhD studies in the same University. Her main current research interests involve the analysis of the impact of maladaptive psychological processes on the evolution of chronic illnesses such as inflammatory bowel disease and cancer. She has published 12 scientific papers in international journals with impact factor and presented dozens of communications in health-related international conferences. She is also a frequent reviewer of several international scientific journals.
Abstract:
The negative impact of inflammatory bowel disease-related symptomatology on patients’ quality of life and level of psychopathology has been reported by several studies. Indeed, IBD is known to hold detrimental effects on the physical and psychosocial functioning of the patients, even when the disease is inactive. Nevertheless, the analysis of the psychological mechanisms that may underlie these effects is yet scarcely developed, even though it has been considered an especially relevant field. We have therefore explored the role of maladaptive psychological processes in IBD using samples of Portuguese patients with Crohn’s Disease and Ulcerative Colitis. Our findings have demonstrated that experiential avoidance, i.e. one’s unavailability to accept internal events such as sensations, thoughts or emotions while trying to control them, mediates the relationship between IBD symptomatology and physical and psychological quality of life. That is, it seems that when patients try to control or avoid sensations like pain or discomfort, or thoughts related to the illness or its symptoms, this strategy holds a paradoxical nature and heightens the effect of those internal experiences on patients’ well-being. Furthermore, we have also recently found that cognitive fusion (the excessive attachment to the content of one’s thoughts) and brooding (a form of rumination defined as the repetitive focused attention on one\\\\\\\'s distress and on its possible causes and consequences) act as significant exacerbators of the association between symptomatology and depression. In fact, for the same level of IBD symptomatology, patients who presented higher levels of those maladaptive processes revealed a significantly higher incidence of depressive symptomatology. These findings suggest that rather than focusing solely on a physical and objective evaluation and approach of patients’ IBD symptomatology, clinicians should also focus on the way patients deal with their symptoms, in order to be able to identify maladaptive emotion regulation processes (e.g., persistent patterns of inflexible thoughts relating to the limitations and consequences of the disease and/or its symptoms; inflexible efforts to avoid or control inner experiences). Furthermore, our results also highlight that psychological interventions that focus on the promotion of adaptive emotion regulation processes to deal with adverse and stressful events should be developed and implemented in IBD patients’ health care.
Keynote Forum
Iftikhar Ahmed
University Hospital Southampton, UK
Keynote: Novel non-invasive diagnostic biomarkers of Inflammatory bowel disease
Time : 13:35-14:00
Biography:
Iftikhar Ahmed is a consultant gastroenterologist at University Hospital Southampton. His research interests include investigating the changes in the smell of faeces and breathe in order to understand the pathophysiological mechanisms of IBD and develop a non-invasive biomarker. Through formal laboratory research, he studied the faecal volatile metabolomics profiles of patients with IBD and irritable bowel syndrome (IBS) in comparison with healthy individuals, and was awarded the degree of Doctorate of Medicine (MD) by University of the Bristol in 2012. He has collaborative research experience with international colleagues, presented his work at both national and international conferences, and was awarded travel grants and prizes for the best abstracts and oral presentations on various occasions. He is on the reviewer panel of several national and international journals, including Gut, PLoS One, Journal of Gastrointestinal and Liver Disease and BMJ.
Abstract:
Diagnosis of inflammatory bowel disease (IBD) requires complex and invasive investigations and places a heavy burden, both on healthcare resources, because of the cost, and on the individual, in times of disease-related disability and poor quality of life. Recently, there has been increasing interest in non-invasive biomarkers to diagnose and monitor the disease activity. Since the introduction of biological therapies, an increasing number of studies have focused on the utilization of non-invasive biomarkers of inflammation. Among the more extensively investigated are standard serum markers such CRP, and faecal biomarkers, such as faecal calprotectin (FC) and lactoferrin (FL). In general, although there are some limitations as these markers are also raised in systemic infection / inflammation, colorectal cancer, NSAID-induced bowel inflammation and polyps. The development of sophisticated analytical techniques has enabled the study and interpretation of changes in the faecal volatile organic metabolites (VOMs) and its correlation with the pathophysiological mechanisms in the gut. VOMs are the chemicals that are the products and intermediates of metabolism and may be altered in different bowel diseases. Changes in faecal VOMs should reflect GI disorders and could potentially provide diagnostic information about these conditions. Multiple studies reported the differences in VOM profiles of healthy controls vs. patients with active and inactive IBD. VOM profiles have been used to segregate patients by disease activity and, in the case of colitis, the type of disease. The correlation of VOMs with microbiota is interesting and supports the hypothesis of gut microbial dysbiosis in the etiology of IBD. This provides an important platform to explore the role of dysbiosis in IBD pathogenesis and development of novel therapeutic targets. In future, further understanding of faecal VOMs may lead to the development of a rapid and simple point of care diagnosis and monitoring of IBD.