Controversies in IBD: Resolving clinical dilemmas using Cochrane reviews
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1 Controversies in IBD: Resolving clinical dilemmas using Cochrane reviews DR. NILESH CHANDE COORDINATING EDITOR, IBD REVIEW GROUP; UNIVERSITY OF WESTERN ONTARIO, LONDON, ON CANADA
2 An international organisation that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care interventions
3 Cochrane IBD review group o636 authors o16 editors o79 published reviews o50 published protocols oimpact Factor 2015: 5.357
4 Cochrane IBD review group o Co-publication agreements with: Inflammatory Bowel Diseases American Journal of Gastroenterology o Concise versions of Cochrane reviews o Wider dissemination to clinicians
5 Symposium format I. Case Study II. Cochrane Evidence III. Panel Discussion Panel members: Dr. Brian Feagan, University of Western Ontario, London, ON, Canada Dr. William Sandborn, University of California San Diego, CA, USA Dr. Fernando Velayos, University of California San Francisco, CA, USA
6 Agenda 1. 5-ASA for the treatment of Crohn s disease - Dr. Stephen Hanauer 2. Strategies for detecting colon cancer in patients with inflammatory bowel disease - Dr. James East 3. Biologics for induction and maintenance of remission in Crohn s disease: a network meta-analysis - Dr. Pieter Hindryckx 4. Withdrawal of drug therapy in patients with Crohn s disease - Dr. Jean-Frédéric Colombel 5. Audience Q & A
7 Special thanks We would like to sincerely thank the following individuals for the important role they played in organizing the DDW Cochrane Symposium 2017: Dr. Ray Boyapati (Monash Health, Clayton, Victoria, Australia; University of Edinburgh, Edinburgh, Scotland) Dr. William Bye (Prince of Wales Hospital, New South Wales, Australia) Dr. Leonard Guizzetti (Robarts Clinical Trials Inc, London ON, Canada) Dr. Vipul Jairath (University of Western Ontario, London ON, Canada) Orli Silverberg (University of Western Ontario, London ON, Canada) Dr. Joana Torres (Icahn School of Medicine at Mount Sinai, New York; Hospital Beatriz Angelo, Loures, Portugal) Sonam Upadhyaya (University of Western Ontario, London ON, Canada)
8 Interested in Authoring a Cochrane Review? Interested in Becoming a Peer Reviewer? Contact Us! John K. MacDonald, Managing Editor jmacdon1@uwo.ca Tran M. Nguyen, Trial Search Coordinator cochraneibdreviewgroup@gmail.com For slides from today s presentation, please visit
9 Case 1 5-ASA for the treatment of Crohn s Disease o 42 year old non-smoking male o RLQ pain and diarrhea for 6 months o Colonoscopy showed ileal Crohn s disease with ulceration without stricturing o MRE showed 10 cm ileal disease o Patient not keen on steroids or immune suppression o Can he be treated with 5-ASA?
10 Case 2 Strategies for detecting colon cancer in patients with inflammatory bowel disease o 61 year old male o Ulcerative pancolitis for 22 years was well on 5-ASA o Flare 5 years ago treated with steroids then transitioned to infliximab and azathioprine o Surveillance colonoscopy shows disease remission but scarring from prior inflammation o Should chromoendoscopy with targeted biopsies be used rather than white light with random biopsies?
11 Case 3 Biologics for induction and maintenance of remission in Crohn s disease: a network meta-analysis o 25 year old female o Bloody diarrhea with abdominal pain and weight loss for 3 months o Colonoscopy shows moderate patchy Crohn s colitis with rectal sparing o No extraintestinal features o Does not want steroids o What treatment do you suggest?
12 Case 4 Withdrawal of drug therapy in patients with Crohn s disease o 59 year old non-smoking female with ileal Crohn s disease for 25 years o Treated in past with steroids and 5-ASA but required extensive 50 cm ileocecal resection with anastomosis 10 years ago for stricturing disease o Flare of symptoms 5 years ago treated with prednisone and azathioprine o Currently in clinical remission with normal fecal calprotectin and CRP o Colonoscopy shows no recurrence at anastomosis o Can this patient stop azathioprine therapy?
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