Inflammatory bowel disease (IBD) can be difficult to diagnose, monitor and manage. The Cochrane Collaboration can help gastroenterologists sort out the useful approaches from the dubious and potentially harmful.

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Nilesh Chande, MD

Nilesh Chande, MD, associate professor of medicine and director of the gastroenterology training program at Western University, London, Canada, will co-moderate the annual Cochrane Symposium Sunday morning at Digestive Disease Week® (DDW). The session is titled Diagnosis, Activity Assessment and Prognosis: What Do Cochrane Reviews Tell us About Patient Management in IBD? William Sandborn, MD, professor of medicine, chief of gastroenterology and director of the Inflammatory Bowel Disease Center at the University of California, San Diego, will also be moderating the session.

“There are two types of IBD in clinical terms,” Dr. Chande said. “Ulcerative colitis has slowly risen in incidence over time, while Crohn’s disease has more rapidly increased in frequency over the last 50 years in many jurisdictions, including North America and most of Europe. The Cochrane Collaboration has done a careful job of assessing the evidence regarding what works, what doesn’t work and what is still uncertain.”

The session’s expert presenters will review the latest science supporting newer modalities such as fecal calprotectin, a biomarker used to assess and monitor IBD activity. Another evolving area involves the use of endoscopic findings to guide therapy for patients with IBD, Dr. Chande said.

“Endoscopy is standard for diagnosis in both Crohn’s disease and ulcerative colitis,” he said. “It is less certain how often and precisely how you should be using the results of subsequent colonoscopies to guide therapy. Gastroenterologists are already adept at using scopes, and reimbursement can be attractive. Using endoscopy as an evidence-based technique to monitor and manage patients will be a good addition to the toolkit that GIs already bring to IBD.”

Improved diagnostic testing is also transforming the management of IBD.

Fecal calprotectin, a measure of intestinal inflammation, is emerging as an early, noninvasive step to diagnose the disease. When patients present with diarrhea that potentially reflects the onset of IBD, calprotectin levels can help point the way to the next diagnostic steps. High calprotectin levels are suggestive of inflammation in the bowel and could indicate the need for continued investigation.

“However, if the symptoms fit with irritable bowel syndrome and fecal calprotectin is normal, you might well be satisfied to not pursue more invasive investigations at that point,” Dr. Chande said. “Fecal calprotectin can be used not only as a diagnostic test but as a way to monitor disease activity in patients who are known to have IBD.”

It is not clear why the prevalence of IBD has been increasing over recent generations, Dr. Chande continued, but the hygiene hypothesis is gaining credence. Children are being born and raised in much more hygienic environments today than they were in the 1950s and earlier. The relatively clean environment means they are exposed to fewer pathogens, parasites and allergens when they are young. As a result, the immune system has less opportunity to learn to regulate its response over multiple exposures and is more likely to overreact to particularly bothersome antigens.

“Asthma, IBD and other allergic conditions are probably worse as a result of the clean environments kids are growing up in these days. Kids that grow up playing in the sandbox, eating dirt and surrounded by pets don’t usually grow up with these allergic kinds of problems,” Dr. Chande said. “We may not be able to do much to prevent IBD, but there are ways we can help patients to manage their symptoms. This Cochrane Symposium will help change your thinking about ways of dealing with IBD and your patients.”

Please refer to the DDW Mobile App or the schedule-at-a-glance in Sunday’s issue for the time and location of this and other DDW events.