#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

#IBDHorizons24 Barahimi Dr Feza Remzi Case: 36yo F with stricture, upstream dilation & abscess on CT. 🩻F/u CT: abscess resolution with antibiotics 🥗mild pain with eating, no fever. 🔦Endoscopy: no other areas of CD inflammation but non-traversable ileal stricture 🤔next steps?

Dr Feza Remzi Matthew Kalady Columbia Colorectal Surgery Ian Daniels FRCS Swedish Gastroenterology @WUGastro Pooja Singhal, MD FACG Arshdeep Singh Benjamin Clement, MD Parambir Dulai Nuha A Yassin #IBDHorizons24 Surgical Panel Barahimi: nutrition build up➡️surg Lum: skip dilation ➡️ surgery Feagan: PREVENT - TNFi PANTS ➡️surg then VDZ Scott D Lee, MD: drain to control & tx with effective. Scope for visual ➡️ surg Dr Feza Remzi: proximal margins & digital exam; temp ileo

#IBDHorizons24 Jacobs Treatments & 1st choice factors: Safety Efficacy- IFX tends to be default Delivery - Keep needle phobia pts in mind; VDZ now subq Comorbidities - communicate with rheum colleagues who use these #IBD meds Severity of dz Age of pt Fight insurance with data

#IBDHorizons24 Jacobs Choosing therapy Panel Subq therapy #BrianFeagan: cynical but look deeper at why data shows differential of IV & subq Rapid fire - VDZ in SB CD? Barahimi: have used VDZ; risa > vdz Jacobs: risa Scott D Lee, MD: SEAVUE Feagan: VDZ shown to work, IPAA is SB.

#IBDHorizons24 #RebeccaFausel The Oregon Clinic How would you answer this Q? Which is TRUE for fecal calprotectin (FCP): A) Level can be elevated in pts on NSAIDs & PPI B) reliable during pregnancy C) Normal range is variable based on pt age D) All of above

#IBDHorizons24 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

#IBDHorizons24 Ghassan Wahbeh, MD How would you answer this? Which is TRUE for POC intestinal ultrasound (IUS): A) Pts fast for 4hrs B) IUS helpful in monitoring #Crohns but not #UlcerativeColitis C) Bowel wall thickness/color Doppler correlate with endo D) There's small radiation

IBDHorizons Ghassan Wahbeh, MD C

#IBDHorizons24 Ghassan Wahbeh, MD Monitoring response to therapy: ‼️Damage ongoing even if inflammation not visible to GI's‼️ 🥼🤝🙋🏼 Determine patient's tx goals Try for MH - STRIDE 🧪Is CRP reliable? NOS #IBD location External factors interfere (age, time of day, meds, comorbs)

IBDHorizons Maia Kayal MD Bincy Abraham, MD, MS Britt Christensen, MBBS MPH PhD Jill Gaidos, MD Marita Kametas Madhuri Badrinath Catherine Bonnar Jessica Philpott IUS shows ⬆️ BWT with loss of wall stratification & potential luminal narrowing but no prox dilatation in this image. If🤰 I’d start EEN, ⬆️ UST to 4wkly & reassess early with FC + IUS and change to anti-TNF if inadequate response academic.oup.com/ibdjournal/art…

#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‼️

#IBDHorizons24 #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 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

#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

IBDHorizons 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!

Elisa Boden, MD IBDHorizons The Oregon Clinic Dr Feza Remzi Bincy Abraham, MD, MS Michael Chiorean Ghassan Wahbeh, MD Scott D Lee, MD Flavio G Rocha, MD, FACS, FSSO Jennifer Fijor OHSU News OregonACP Thank you for joining us today. We're thrilled to have had you be a part of the day's events. #IBDHorizons24

Higher ustekinumab concentrations associated with less inflammation on cross sectional imaging on #mri in #crohns disease pubmed.ncbi.nlm.nih.gov/36421052/ Michael J Rosen, MD, MSCI Uma Mahadevan Ryan Ungaro MD MS

That's a wrap 🎬 1️⃣ City of Roses 🌹 IBDHorizons X The Oregon Clinic Symposium. Thank you Dr Don Lum, all Faculty Speakers, Industry Partners and our fantastic, engaged Attendees. See you in 2025, PDX! #IBDHorizons24 Join us for an upcoming Symposium 🔗ibdhorizons.org

On #WorldIBDDay, #IBDHasNoBorders Across the globe we are: 👩🏻‍🏫Educating clinicians & our patients with #IBD 👩🏻‍🎓Researching treatments 🎗Raising awareness 👷🏻‍♀️Building #IBDCenters Together, we fight IBD. To our patients: We’re 🥊 with you #WorldIBDay2024 #IBDAwareness