Disclaimer: This article was written after attending AIBD 2021; all information is presented as an attendee to the conference, not as a presenter.
While I was looking forward to pretty much every presentation at AIBD, I was especially interested in Session IIIC: Innovations and Approaches in IBD Care for Children With IBD. With an all star lineup of presenters including Dr. Eric Benchimol, Dr. Lindsey Aldenberg, Dr. Sandra Kim, Dr. Andrew Grossman, and Dr. Kevin Mollen, this session was a must see for me. Not only were the presenters themselves exciting, but their topics explored the growing world of pediatric IBD management. There was a lot of information, so I’ve decided to summarize the presentations in this session and highlight the key findings and takeaways.
Pediatric IBD Year in Review
Presented by Eric Benchimol, MD, PHD, FRCPC
Dr. Benchimol had the herculean task of presenting a yearly review of 2021 in just a 20 minute time slot, and he nailed it! Some of finding over the last year include:
COVID 19
Lower risk of severe COVID-19 in patients on a biologic
Higher risk of severe COVID-19 in patients taking steroids
Patients reported high amount of fear regarding developing COVID-19 and attending medical facilities
Evidence suggests a third dose of the COVID-19 vaccine will likely be needed to maintain antibody levels in IBD patients
Growth in children with IBD has improved over the last 10 years
The racial disparity between steroid prescriptions in black and white children has lessened dramatically over the past 10 years
The STRIDE-2 publication better defines targets of treatment in pediatric IBD
Diet and IBD: Translating Research into Real-Life Practice
Presented by Lindsey Aldenberg, DO
Dr. Aldenberg presented on my favorite topic: diet and IBD. I was so excited to hear this talk, and even more excited to share the key takeaways with you below:
The incidence (number of new cases) of IBD is increasing worldwide, and closely mirrors industrialization
The genetic contribution to the development of IBD is at most 30-40%; this leaves environmental factors, including diet, to make up the remainder
The gut microbiome is dysbiotic (abnormal) in patients with IBD, and diet plays a key role in shaping the gut microbiome
Ultra-processed foods have been associated with development of IBD in recent studies, and this may be due to food additives that disrupt the microbiome and the strength of the gut barrier
Exclusive Enteral Nutrition is an effective therapy in pediatric IBD and is often used as an alternative to corticosteroids or as a bridge to other therapies, medication, or whole food therapeutic diets.
The results of the DINE-CD study, which compared the mediterranean diet with the specific carbohydrate diet, showed that there was no significant difference between the diets when looking at clinical remission and inflammation.
Dr. Aldenberg’s take home points from DINE-CD were that the mediterranean diet may be a great option for IBD patients, and both the mediterranean diet and specific carbohydrate diet might have a greater effect on symptoms than inflammation
The Crohn's Disease Exclusion Diet was effective in lowering measures of inflammation in IBD, and there appears to be a response as early as 3 weeks in patients on the Crohn’s Disease Exclusion Diet or Exclusive Enteral Nutrition
There may be a subset of IBD patients who have disease that responds well to diet therapy, and this needs to be further explored with more research
Cost and Access to Care in Pediatrics
Presented by Sandra Kim, MD
Dr. Kim discussed the urgent need for better access to care for IBD patients and put a spotlight on one of the largest barriers for patients: cost. Some of the highlights from the talk are:
If patients cannot access their doctors, treatments, and medications, then the advances we are making matter less and have less impact
Cost is the biggest delay in receiving care as reported by patients
Per patient costs are greater in children vs adults with IBD
The costs for IBD patients has risen primarily due to pharmaceutical costs, of which biologics are the largest contributor
The group most affected by financial stress are families within the 50-100k earning bracket
Delays in prior authorizations have lead to an increased use in steroid use, which is a medication that pediatric IBD providers try to avoid prescribing
The concept of Step Therapy/Fail First by insurers is harmful to our patients. This policy requires patients and providers to use mandated therapies rather than those that the doctor/providers believes will be most effective. This can lead to delays in the patient getting the therapy that works best for them, and may result in a longer and more difficult path to remission
Advocacy for change in cost and patient access can be done at a individual, state, and national level
The “Safe Step” act of 2021 will allow for a clear, transparent appeals process to request exemption among other advances. Keep an eye on this bill
Social media is a platform we can use to advocate for lower costs and improved patient access
Don’t Be Late to the Party: When to Call Your Surgeon
Presented by Kevin Mollen, MD
Dr. Mollen touched on the importance of getting the surgeon involved early in the care of IBD patients. Some of points I found most important are:
Many studies highlight that surgery is a major cause of anxiety for patients with IBD
Patients often view surgery negatively prior to the operation, but afterwards view surgery positively; patients often wished that they had considered surgery earlier
A multidisciplinary approach to surgical care has been shown to improve preoperative optimization of surgery, decrease surgical complications, and likely improve patient satisfaction
An early consult with the patient allows the surgeon to:
Set expectations
Lower anxiety
Optimize the patient preoperatively
Plan the surgery at the optimal time
A poor nutritional status prior to surgery is associated with prolonged hospital stay, postoperative complications, and delayed recovery of bowel function. Short term nutritional interventions may be used to improve nutritional status prior to surgery
Any patient with UC that is admitted to the hospital for an acute flare should receive a consult from the surgeon due to the high likelihood of needing surgical interventions
In summary, it is key to communicate with the surgeon to develop a plan based on the patient’s goals to improve patient and parent satisfaction. Surgeons are a key part of the IBD multidisciplinary team
