GASTROENTEROLOGY
smooth and supportive transition to enable young adults to lead normal lives and prevent the disease from impacting their education and lifestyle,” said Professor Siegmund. As well as IBD, the BTP also includes other long-term paediatric conditions, such as juvenile diabetes, epilepsy, arthritis, kidney disease and asthma. When a patient is included in the programme, a case manager is assigned who takes care of all the practical issues, maintains contact with the patient throughout the process and ensures that they are comfortable throughout the programme. Where needed, the patient can see both their paediatrician and their new treatment team during the transition. Providing all the materials, structure and
support required to transition children safely, Professor Siegmund hopes that the success of the programme will provide a framework that can be incorporated across the rest of Europe. She explained: “The BTP can serve as a role model that can be adapted to the health service of each country. One of the critical success factors for the programme is to ensure that children are transitioned into the care of specialists who really understand adolescents and are willing to invest the time in them. All physicians who agree to take part in the programme fulfil this requirement and are committed to the success of the project.” For more information on the BTP, please visit: http://www.drk-kliniken-
berlin.de/westend/krankenhaus-westend/ berliner-transitionsprogramm/
Classification of functional gastrointestinal (GI) disorders
European clinicians and research scientists attending UEG Week 2016 also welcomed the publication of new criteria for the diagnosis and classification of functional gastrointestinal (GI) disorders, together with the launch of several major initiatives designed to enhance understanding of these disorders and help clinicians in the care of their patients. Delegates attending UEG Week in Vienna embraced the initiatives, which have been inspired by publication of the new Rome IV criteria for functional GI disorders14
and were showcased by
Dr Douglas A. Drossman, the current president of the Rome Foundation. Speaking at UEG Week, Dr Drossman outlined the need to update the definitions and conceptual understanding of functional GI disorders, leading to the development of the Rome IV classification and the research and educational initiatives that have followed. “The Rome III criteria were published in 2006 and, in the last 10 years, we have seen unprecedented progress in our understanding of functional GI disorders and now have better treatments available for many of them,” he said. “In developing the Rome IV criteria, we wanted to include new diagnoses, emphasise the importance of the gut-brain interaction in the pathophysiology of these conditions, and improve their diagnosis and treatment using new learning tools.”
FEBRUARY 2017
The Rome IV criteria contain a number of major changes, which were based on both new evidence and expert consensus. These include: l The redefinition of functional GI disorders as ‘disorders of the gut–brain interaction’ and the removal of the term, ‘functional’ when not needed.
l The addition of new diagnoses, including opioid-induced constipation, narcotic bowel syndrome, cannabinoid hyperemesis syndrome and reflux hypersensitivity.
l Threshold changes for diagnostic criteria to improve their clinical meaningfulness. · Revision of sphincter of Oddi (SOD) disorder criteria.
l Reconceptualisation of IBS and its sub-types, with removal of the term ‘discomfort’ from its diagnostic criteria.
“These changes reflect our growing understanding of many different aspects of functional GI disorders and they should help support future research and enhance clinical practice,” said Dr Drossman. “We now want to help clinicians in Europe and around the world to understand the new criteria, integrate them into their own diagnostic work- ups and optimise their patient management.” To aid in the communication of the Rome IV concepts to clinicians, the educational materials have been published as the Rome IV 2-volume textbook and also supplementary clinically oriented books. These include diagnostic algorithms, multimodal treatment using the Multi-Dimensional Clinical Profile, as well as paediatric and primary care books. “In this manner, the clinician can find the book that is best targeted to his or her specific interests,” said Dr Drossman. As a means to further reach the needs of clinicians, the Rome Foundation has been working with new software to develop a powerful on-line, interactive toolkit that presents a combination of Rome IV diagnostic algorithms and Multidimensional Clinical Profile (MDCP) treatment guidelines.15 The toolkit guides clinicians through the complex challenges of working with patients with functional GI disorders, with users seeing all relevant decision pathways, and, by inputting their patients’ information, activating the pathways that lead to treatment recommendations for optimal outcomes. “Both the Rome IV diagnostic criteria and the MDCP guidelines are innovative in their learning approaches and we are pleased to have been able to combine these approaches in this interactive on-line toolkit,” explained Dr Drossman. “We anticipate that clinicians will be able to develop a more comprehensive knowledge and optimise the care of their patients by accessing the most up-to-date information developed by world experts.” CSJ
References
1. Zevallos V, Weinmann-Menke J, Meineck M et al. Alpha-amylase/trypsin inhibitors (ATIs) accelerate murine systemic lupus erythematosus. Poster presentation at the 16th International Coeliac
Disease Symposium, 21–24 June 2015, Prague, Czech Republic. Poster P168.
2. Zevallos V, Yogev N, Nikolaev A et al. Consumption of wheat alpha-amylase/trypsin inhibitors (ATIs) enhances experimental autoimmune encephalomyelitis in mice. Oral presentation at the 16th International Coeliac Disease Symposium, 21–24 June 2015, Prague, Czech Republic.
3. Junker Y, Zeissig S, Kim S-J et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med 2012;209 13:2395-408.
4. Fasano A, Sapone A, Zevallos V et al. Nonceliac gluten and wheat sensitivity. Gastroenterology 2015;148 6:1195-204.
5. Schuppan D, Pickert G, Ashfaq-Khan M et al. Non-celiac wheat sensitivity: Differential diagnosis, triggers and implications. Best Pract Res Clin Gastroenterol 2015;29 3:469–76.
6. Böhn L, Störsrud S, Liljebo T et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015;149 6:1399–1407.
7. Halmos EP, Power VA, Shepherd SI et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146 1:67–75.
8. Halmos EP, Christophersen CT, Bird AR et al. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 2015;64 1:93-100.
9. Bennet SMP, Böhn L, Störsrud S et al. Multivariate modelling of gut microbial profiles predicts responsiveness to a diet low in FODMAPs. Oral presentation at UEG Week 2016, 15–19 October, Vienna, Austria. Abstract 3474. 10. UEG EU Affairs. Paediatric Digestive Health Across Europe: Early Nutrition, Liver Disease and Inflammatory Bowel Disease. Available at:
https://www.ueg.eu/epaper/UEG_Paediatric_ Digestive_Health_Report/
index.html 11. Baldassano RN, Piccoli DA. Inflammatory bowel disease in pediatric and adolescent patients. Gastroenterol Clin North Am 1999;28:445–58.
12. Trivedi I, Holl JL, Hanauer S et al. Integrating adolescents and young adults into adultcentered care for IBD. Curr Gastroenterol Rep 2016;18:21.
13. The IMPACT Survey, 2011, EFCCA. Available at:
http://efcca-solutions.net/ 14. Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE (eds). Rome IV functional gastrointestinal disorders: disorders of gut–brain interaction. Raleigh, NC: Rome Foundation, 2016. 15. Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE and the Rome IV Committees (eds). Rome IV Multidimensional Clinical Profile for Functional Gastrointestinal Disorders (2nd edition). Raleigh, NC: Rome Foundation, 2016.
UEG, or United European Gastroenterology, is a professional non-profit organisation combining all the leading European societies concerned with digestive health. Its member societies represent over 22,000 specialists, working across medicine, surgery, paediatrics, GI oncology and endoscopy. The 25th UEG Week will take place in Barcelona, 28 October to 1 November 2017.
www.ueg.eu
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