Disclosures

• This conference is sponsored by the following grant:– University of Alberta FOMD Conference/Symposium Fund

• The MCIBD series is supported by – unrestricted educational grants from the following companies

Aim of today’s meeting

• To bring together the members of the multi-disciplinary team who are involved in the care of people with IBS and IBD

• In order to examine the importance of mental health issues in patients living with chronic illness

Objectives

By the end of today’s meeting, participants will

1. Review IBD and impact of chronic illness on patients

2. Examine the importance of mental health issues in patients with chronic (bowel) illnesses

3. Explore strategies to manage chronic pain in patients with IBS and/or IBD

4. Examine alternative therapies patients can use to cope with chronic illness

Conference Materials

• Syllabus booklet– Agenda– Workshop cases

• Workshop groups

• Resource handouts– Guidelines and protocols

• Personal Learning Program (PLP) for CME credits to submit according to your discipline

• Program evaluation (feedback) form

Why Mind and GUT MCIBD?

• Irritable Bowel Syndrome (IBS)– High level of daily impairment in patients with IBS (~76%)– Presence of depression and insomnia is assoc. with IBS

• Inflammatory Bowel Disease (IBD)– Patient reported symptoms and clinical scores are poor

predictors of mucosal inflammation– High rate of comorbid anxiety and depression in patients with IBD

Ballou et al 2017. Neurogastroenterol MotilLee et al. 2017 J Psychosom Res

Ford et al. 2016 Inflamm Bowel DisSulman et al. 2015 Inflamm Bowel Dis

Graff et al. 2016 Inflamm Bowel Dis

Coexisting IBS-IBD and increased psychological comorbidities

• At least 20% of IBD patients have coexisting IBS

Abdalla et al. 2017 Inflamm Bowel Dis

Higher narcotic use in IBD-IBS patients compared to IBD alone

• Quality of Life is lower in patients with IBD-IBS vs IBD alone

• IBD-IBS associated with• anxiety• depression• fatigue• sleep disturbances• pain interference• decreased social satisfaction

Finlay 2016. Cellular Microbiology

Figure. Neuromodulators and structure of the gut microbiota-brain axis.

Mind-Gut link

Regueiro et al. 2017 Gastroenterol

Figure. Behavioral Inhibition and behavioral activation systems and chronic pain is associated with negative emotions, catastrophic thinking, and inhibition of activity, which all, in turn, lead to increased pain perception.

Pain perception

Regueiro et al. 2017 Gastroenterol

Figure. IBD subspecialty medical home. A patient-centered, team-based collaborative care model of care. The solid blue arrows show the patient’s trajectory with different team members in the subspecialty IBD medical home. The red arrows are team members located outside the home. The blue dotted arrows represent the different ways that telemedicine options are used both for remote monitoring and virtual care access.

Take-home

• multidisciplinary discussion and collaboration

• updating knowledge – tools for clinical practice

• increased awareness – resources and support

• hours for Continuing Medical Education credits per profession – at the end of the day hand in your evaluation form at the registration desk and receive your Certificate of Attendance