Henriette Heinrich (Switzerland) opened the session by emphasizing the goal of helping clinicians identify and avoid errors that can lead to suboptimal patient care. Mistakes in diagnosing and managing lower GI diseases, including IBD and fecal incontinence, are not only common but also have a high clinical impact. The session sought to bridge gaps between evidence-based knowledge and everyday clinical challenges, particularly when dealing with complex, chronic conditions.
Joachim Høg Mortensen (Denmark) delivered a presentation on the pitfalls in using biomarkers for IBD. While biomarkers are essential for diagnosing and monitoring IBD, Mortensen pointed out several technical and clinical mistakes that clinicians often make.
Mortensen stressed the importance of understanding the biological and clinical significance of each biomarker. For instance, calprotectin levels are widely used to assess inflammation, but not all elevated levels are indicative of active IBD. Clinicians must consider other factors, such as infections or NSAIDs (Non-steroidal anti-inflammatory drugs) use, which can elevate calprotectin independently of IBD activity.
Another frequent error is over-reliance on C-reactive protein (CRP) as an indicator of disease activity. While CRP is useful in Crohn's disease, it is less sensitive for isolated small bowel disease. Mortensen suggested that combining multiple biomarkers, such as calprotectin and serum levels, could improve diagnostic accuracy and treatment decisions.
Mortensen emphasized that only validated biomarkers should be used, and clinicians should understand their limitations. He called for the use of more biomarkers reflecting mucosal damage and fibrosis to provide a fuller picture of disease activity and prognosis.
Richard Russell (United Kingdom) addressed common mistakes in the management of pediatric IBD, highlighting the unique challenges that arise in treating younger patients.
Pediatric IBD often presents with subtler symptoms than in adults, leading to delayed diagnoses. Early signs like failure to thrive, fatigue, and intermittent abdominal pain are sometimes misinterpreted as functional GI disorders or minor gastrointestinal infections. Russell urged clinicians to have a higher index of suspicion when children present with these non-specific symptoms, suggesting early use of fecal calprotectin as a screening tool to avoid delays in diagnosis.
The increasing incidence of pediatric IBD, especially in countries like Scotland where Crohn's disease rates are among the highest in the world, underscores the need for timely intervention. If not diagnosed early, these children often transition into adulthood with long-standing disease, complicating future management.
Failure to regularly monitor growth is a critical oversight in pediatric IBD management. Growth failure can be an early sign of uncontrolled disease, particularly in Crohn's disease, where malnutrition and chronic inflammation can severely affect a child's growth trajectory. Russell emphasized that height and weight should be assessed at every visit, and any stagnation in growth should prompt a re-evaluation of disease control.
Moreover, the limited availability of approved biologic therapies for children remains a challenge. While adults with IBD have access to a broader range of treatments, pediatric patients often have to rely on anti-TNF agents as first-line biologics. Russell highlighted the need for greater advocacy to expand the range of approved therapies for younger patients to avoid long-term complications and allow for more personalized treatment plans.
Exclusive enteral nutrition (EEN) is an underutilized treatment in pediatric IBD, despite its efficacy in inducing remission, particularly in Crohn's disease. Russell advocated for the greater use of EEN as a non-pharmacologic option for inducing remission, especially given its ability to avoid the side effects of steroids in growing children. While challenging for patients and families to adhere to, EEN offers a valuable option that should not be overlooked.
Daniel Keszthelyi (Netherlands) discussed mistakes in managing fecal incontinence, a condition that is often underdiagnosed and inadequately treated despite its significant impact on quality of life.
Keszthelyi emphasized that fecal incontinence is not a diagnosis in itself but rather a symptom that may arise from various underlying conditions, such as IBD, colorectal cancer, or irritable bowel syndrome. A thorough evaluation, including a detailed history and physical examination, is essential to identify the underlying cause.
Conservative management, such as dietary changes and pharmacotherapy, is the first line of treatment, but Keszthelyi warned that clinicians often rely too heavily on these approaches. For patients with persistent symptoms, more advanced interventions, such as sacral nerve stimulation or biofeedback therapy, may be necessary.
In closing, Henriette Heinrich reiterated the session’s focus on learning from mistakes to improve patient care. She encouraged clinicians to remain vigilant in their use of biomarkers, especially in IBD, and to adopt a more proactive approach in managing pediatric patients and fecal incontinence. By addressing these common errors, clinicians can improve both diagnostic accuracy and treatment outcomes for their patients.