Falk Sympozium 202 –  Vyvíjející se terapie v klinické praxi u IBD

It is with greatest pleasure to report from the excellent Falk Symposium 202 held in Prague from 29^th to 30^th April 2016. The program “Evolving therapies in clinical practice in inflammatory bowel disease (IBD)” organized by Prof. Milan Lukas (Prague, Czech Republic), Dr. Martin Bortlik (Prague, Czech Republic), Prof. Eduard Stange (Stuttgart, Germany) and Prof. Wolfgang Kruis (Cologne, Germany) attracted a record 840 attendants from 42 countries. The overarching theme of the conference was the discussion and application of current and future strategies in IBD therapy, which was supported by an internationally recognized faculty. The sessions covered a blend of cutting edge, upcoming and controversial topics in the care of patients with IBD.

Prof. G. Rogler (Zurich, Switzerland), Prof. B. Sands (New York, USA) and Prof. E. Stange (Stuttgart, Germany) summarized novel approved and upcoming therapeutic approaches in the medical therapy of IBD patients. This included biologic therapies, such as anti-cytokine strategies, including anti-interleukin (IL)-12/ 23 or the new Janus kinase (JAK) inhibitors. In addition the now approved drug class of anti-leukocyte trafficking was discussed. An entirely novel concept, the improvement of the “leaky” intestinal barrier, could revolutionize IBD therapy in the future.

Session two focused on a Cinderella story and unmet need in IBD –  Intestinal fibrosis. Dr. F. Rieder (Cleveland, USA) stated that novel pathogenetic pathways of fibrogenesis may offer therapeutic targets in the future. Tremendous advances have been made for the detection of fibrosis by biomarkers or cross-sectional imaging, such as ultrasound or MRI and will help with making clinical trials of anti-fibrogenic medications a reality (Prof. P. D. Higgins, Ann Arbor, USA). When medical therapy fails surgical approaches are often needed in patients with intestinal strictures and those include endoscopic surgery, bowel preserving surgery and resection (Prof. Y. Panis, Paris, France).

The expertise and curiosity of the audience was challenged by clinical cases on controversial topics. Perianal Crohn’s disease (CD), severe ulcerative colitis (UC) and immunosuppressive medications in IBD patients with malignancy were discussed by master clinicians, including Prof. P. L. Lakatos (Budapest, Hungary), Dr. Z. Serclova (Prague, Czech Republic), Prof. A. E. Dorofeyev (Kiev, Ukraine), Dr. M. Marti Gallostra (Barcelona, Spain), Prof. G. Novacek (Vienna, Austria) and Prof. J. Cosnes (Paris, France) with active participation by the visitors of the symposium.

The first day was rounded up by reports on optimizing current therapies for IBD in the perioperative setting (Prof. A. U. Dignass, Frankfurt, Germany), combination therapies of existing IBD medications (Prof. W. Kruis, Cologne, Germany) and the use of drug levels and antibodies in clinical practice (Prof. A. Gils, Leuven, Belgium). A highlight of the conference, presented by Dr. D. Duricova (Prague, Czech Republic), was the lessons learned by epidemiological studies in IBD.

Biosimilars are in the process of being approved all over Europe and may represent a valid alternative to current biologic therapies. After an overview talk on biosimilars and their possible future influence on IBD treatment algorithms (Prof. B. Moum, Oslo, Sweden) clinical experiences were presented from countries, in which biosimilars are already available, such as Norway (Dr. J. Jahnsen, Nordbyhagen, Norway), Czech Republic (Prof. M. Lukas, Prague, Czech Republic) and Hungary (Prof. P. L. Lakatos, Budapest, Hungary). This data will help to define the role of this novel biological medical product.

For patients in whom all therapies fail, transplantation procedures may become an alternative approach. We now have trials of autologous haematopoietic stem cell transplantation and mesenchymal stem cell therapy in CD completed or on the way (Prof. C. J. Hawkey, Nottingham, UK and Prof. G. M. Forbes, Perth, Australia). While the initial experience with faecal transplantation as an IBD therapy was mixed we now gather encouraging new information making this a possible novel therapy in the future (Prof. W. Reinisch, Hamilton, Canada). Understanding of small bowel transplantation is evolving and centers of excellence present improving long term outcomes in patients with short-gut syndrome (Dr. P. Drastich, Prague, Czech Republic).

In the last session of the symposium Dr. M. Bortlik (Prague, Czech Republic), Dr. T. Molnar (Szeged, Hungary), Dr. M. Protic (Belgrade, Serbia), Dr. Z. Zelinkova (Bratislava, Slovakia), Dr. M. Diculescu (Bucharest, Romania) and Dr. J. Orhalmi (Hradec Kralove, Czech Republic) practically applied the previously acquired knowledge by discussing challenging clinical cases about overlaps of CD and UC, ileal pouch anal anastomosis patients, IBD in pregnancy and terminal ileal CD. The special lecture, a distinguished honor of a Falk Symposium to Prof. H. Tlaskalova-Hogenova (Prague, Czech Republic), discussed recent advances in the intestinal microbiome.

The scientific exchange between the world-class faculty and the international audience, however, did not stop at the general session, but was also apparent during the poster sessions, in which 110 distinguished abstracts were discussed. The conference was framed with a very well organized social program with a welcome dinner and a gala-dinner at the Municipal House.

I sincerely appreciate the opportunity to be part of this distinguished and interactive meeting and the organizers are to be congratulated on gathering this outstanding faculty and audience.

Florian Rieder, MD

Department of Gastroenterology, Hepatology and Nutrition

Digestive Diseases and Surgery Institute

Cleveland Clinic Foundation

2049 E 100th Street

Cleveland, Ohio 4419, USA

riederf@ccf.org