Key Takeaways from Crohn’s & Colitis Congress 2023
Published: February 24, 2023
The Crohn’s & Colitis Congress 2023 took place last month in Denver, Colorado, bringing together more than 1,300 healthcare professionals and researchers from across the globe to share the latest advancements in inflammatory bowel disease (IBD)
Here’s a look at some of the key presentations and takeaways from our patient reporter, Tina Aswani-Omprakash.
Crohn’s & Colitis Congress 2023 kicked off in a grand way with important case studies during what is called the IBD A-Z sessions. Session co-moderators, Drs. Florian Rieder and Christina Ha, along with Congress co-chair, Dr. Laura Raffals, hosted a fast -paced, interactive case-based discussion on managing Crohn's disease and ulcerative colitis utilizing medical therapies, dietary strategies and mental health considerations. The objective of these sessions was really to bring home to gastroenterologists complex real-world cases and how they were managed. It was really empowering as a patient to see our healthcare providers equipped to understand what is essential in our care and how a multidisciplinary care model is truly needed for us patients to achieve optimal quality of life.
One of the main takeaways that stood out was that IBD centers should work with other specialists (on extraintestinal manifestations), behavioral therapists (on management of mental health), dietitians (on optimal diet and nutrition), radiology & pathology (on accurate diagnosis and treatment via imaging/biopsies) and colorectal surgery (on initiating early action if surgery may be necessary). The only thing I would personally add to this is working with physical therapy (particularly pelvic floor PT) to optimize physical activity, fitness and recovery for IBD patients. This multidisciplinary approach provides the best model for care for patients and the best overall outcomes.
There were important presentations that first day around Diet & Nutrition in the Pediatric & Advanced Practice Provider (APP) tracks. Several registered GI dietitians were present at the APP track sharing various recommendations, including not over-restricting diets and managing malnutrition by Therezia Al-Choufete and Laura Manning. Al-Choufete focused on modifying textures, shapes and sizes of foods to ensure patients are getting a variety of nutrients in their diets, preventing malnutrition. Neha D. Shah also shared how important it is to consider social, economic, and cultural influences on patients’ dietary habits when making dietary recommendations to patients of various racial, ethnic, and socioeconomic backgrounds. What works in the typical American diet may be very different in the growing immigrant population being diagnosed with IBD here in the United States.
Some of the main sessions on day two included IBD Therapeutics in 2023, Controversies in IBD: Shark Tank and Hot Topics in IBD Research. During the IBD Therapeutics session, Dr. Edward Loftus masterfully discussed recently approved and emerging therapies. He shared that while there are very few head-to-head studies comparing different medications in the IBD space, physicians can share best practices based on what they have seen and felt comfortable trying in the clinic.
He also went into the how’s and why’s of dual targeting therapy, meaning how to use combinations of advanced therapies (biologics and/or JAK inhibitors) to achieve better outcomes in patients with complex penetrating disease. While many of us patients are often concerned about safety when it comes to these advanced therapies, Dr. Loftus did say the safety was still relatively decent in the combinations he discussed and that efficacy was better than monotherapy.
In another presentation on dual-targeted therapies, Dr. Laura Targownik corroborated many of Dr. Loftus’ statements. Dr. Targownik explained the VEGA & EXPLORER trials, combining Guselkumab + Golimumab and Adalimumab + Vedolizumab + Methotrexate, respectively. She explained that while these trials exist and are shaping the future of combination therapies for IBD, pharma companies will need to cooperate and collaborate to ensure these trials are occurring. Otherwise, there will continue to be lack of evidence to really break through current therapeutic ceilings to help patients achieve better quality of life without too many side effects.
During the Shark Tank session, many topics came up for debate amongst gastroenterologists, surgeons, and multidisciplinary clinicians. It was really interesting to see the different approaches many had and how ideas could converge to help patients the most. Some of the key themes discussed during this session including involving colorectal surgery early rather than allowing surgery to become emergent. This allows for acceptance in the patients’ minds and limits making surgery a last resort when it is an important and necessary treatment option oftentimes. Another topic that arose was around timing of colorectal surgery and the use of biologics postoperatively. Dr. Stefan Holubar emphasized that biologic exposure is generally not associated with post-op infections and/or worse outcomes for patients but that surgeons should always exercise caution and work with gastroenterologist to come up with the best care plan personalized to the patient.
What’s important to remember here for us patients and our caregivers is that while safety of these therapies should always be on our minds, this disease running rampant without intervention can be far more dangerous. Considering monotherapy, combination therapies and/or surgery proactively and in a timely fashion as recommended by our physicians plus multidisciplinary care coordination is a key message from this conference.
So what’s new and on the horizon for us patients to look forward to in the IBD space? On the second and third days of the Congress, many important new tools and developments were discussed.
There are many advancements emerging particularly for perianal fistula, a huge unmet need in our community that can really have devastating physical and mental effects on us patients. Dr. Amy Lightner went into some of the surgical techniques she uses to locally place stem cells on the site of perianal fistulae during endoscopies to target healing. Her overall message was that mesenchymal stem cells are quite effective and very safe to use. There are very low rates of systemic infection or complications in spite of some localized pain upon administration.
Dr. James Lewis also discussed Dr. Louis Cohen’s work on autologous stem cell transplant, a process that shuts down the immune system and uses stem cells to reset the immune system into a healthy, more functional one. This a new potential treatment option for Crohn’s patients who are not responding to existing therapies and resets the immune system so that patients can respond to therapies and have quality of life. There has been quite some success with this but it is not a cure for IBD. It is a more extreme measure that requires several weeks in the hospital in isolation and patients are successfully put back on therapies, such as Vedolizumab, within months after treatment.
Dr. James Lewis also discussed a path to a cure for IBD. He said while there are certain potentially modifiable risk factors, the reality is there are genetic components as well to this disease. His hope in the near term is looking to prevent the onset of IBD.
There were many methods of prevention and halting the progression of IBD discussed at Congress, including a variety of new less invasive technologies. For instance, Dr. Michael Dolinger talked about more remote monitoring of disease activity including wearable technologies, so bioadhesives, or stickers, sweat sensors, etc., that monitor biomarkers and alert our physicians as to when a flare might be coming so as to act quickly and prevent onset. Dr. Dolinger, pioneer of intestinal ultrasound (IUS) in the U.S., also discussed how IUS is effective for not just Crohn’s disease, but also in outpatient bedside monitoring of ulcerative colitis. How? Once a medication is prescribed, physicians can use IUS to see if the medication is working by rates of inflammation coming down. It’s easy, quick and not invasive for patients and can be done in the office, which could be a gamechanger once instituted across the U.S.
One of the most fascinating presentations at the Congress was one about precision nutrition by Dr. Berkeley Limketkai. Dr. Limketkai discussed the development of artificial intelligence (AI) models for precision nutrition in IBD care in order to predict and manage flares. Here’s the thing: the same diet does not work equally across all patients. So, AI models can be used to predict which diets work best for whom. The models can also design optimal diets based on a patient’s clinical profile and history.
All of these remote monitoring technologies, new medications, precision medicine and nutrition tools are the future of IBD care. I knew that as I was leaving snowy Denver that there will be greener pastures for us patients to look forward to. This conference exuded hope in my mind and showed that the future is a lot brighter than we may have otherwise thought. A lot is happening and moving in the space right in front of our eyes! What made this such a wonderful conference was seeing practitioners and researchers who have our backs and really, truly care to make our well-being the top priority!
To summarize some of my key takeaways:
- Multidisciplinary care is key!
- IBD centers should work with mental health practitioners, dietitians and colorectal surgery as needed to optimize patient care
- Diet & nutrition – food-related quality of life, sociocultural concerns, prevent over-restriction and malnutrition
- Lots of new monitoring technologies & treatment modalities
- Wearables & Stickers
- Stem cells
- Can we intercept IBD development and prevent onset?
- New medications are available & more on the way
- How do we position which medication is first, second, third in line for treatments?
- Can we use combination biologics & small molecules?
**Goal is to improve patient care by halting progression of disease**
So, own your Crohn’s, own your ulcerative colitis, and stay abreast of the latest and greatest research in the IBD space to advocate for your own best care!
Tina Aswani-Omprakash is a Crohn's patient, health advocate for the chronically ill and disabled, and founder of the blog Own Your Crohn's and the nonprofit charitable organization South Asian IBD Alliance.