Monitoring Of Inflammatory Bowel Disease Research Articles

Turbidimetric Determination of Fecal Calprotectin Using Two Table Top Chemistry Analyzers: Mindray BS-200E and Cobas® c111.

Fecal calprotectin assays are widely used in diagnosis and monitoring of inflammatory bowel disease (IBD) in patients with suspected IBD. The most frequently used technique is ELISA and microtiter plates. Turbidimetric assays for analysis of fecal calprotectin can significantly reduce turnaround time. Many laboratories may be reluctant to run fecal samples on their large chemistry analyzers. The aim of this study was to evaluate fecal calprotectin particle enhanced turbidimetric immunoassay (PETIA) on smaller chemistry analyzers that could be dedicated for fecal samples. The BÜHLMANN fCAL® turbo assay was validated on two table top chemistry analyzers, Mindray BS-200E and cobas® c111. The assay was linear in the range between 20 and 1,900 µg/g with a limit of quantification around 20 µg/g on both instruments. The total coefficient of variation was < 7% in the range between 50 and 1,300 µg/g on both instruments. No antigen excess hook effect was observed up to 18,000 µg/g on the Mindray BS-200E and up to 20,000 µg/g on cobas® c111. The BÜHLMANN fCAL® turbo assay showed a high correlation with the BÜHLMANN fCAL® ELISA. Running the BÜHLMANN fCAL® turbo on Mindray BS-200E or cobas® c111 chemistry analyzers can provide rapid test results without exposing large routine chemistry analyzers to stool samples.

Paediatric reference ranges for faecal calprotectin: a UK study

Background Faecal calprotectin has been shown to be a useful non-invasive marker for the diagnosis and monitoring of inflammatory bowel disease in children and adults. Although there are well-established reference ranges for the diagnosis of inflammatory bowel disease in adults, these have been less well studied in children. The objective was to establish reference ranges in our local population. Method All faecal calprotectin results from 2011 to 2014 were retrospectively collated and grouped according to patient age. Probability plots were used to determine expected upper limit of normal for each age group, and Mann-Whitney test was used to determine statistical difference between groups. Results Upper limit of normal for age groups 1-3.9 years, 4-17.9 years and 18 years plus were 77, 62 and 61 µg/g, respectively. There was a significant difference ( P = 0.0013) between the median calprotectin concentration for the age group 1-3.9 years ( n = 87) and 4-17.9 years ( n = 636) and between the age group 1-3.9 years and 18 years plus ( n = 7953, P = 0.0001), but there was no significant difference between the age groups 4-17.9 years and 18 years plus ( P = 0.4206). Conclusions In our local population, faecal calprotectin varies with age. Children aged 1-3.9 years had higher concentrations of faecal calprotectin than adults, but there was no significant difference in faecal calprotectin between older children and adults. This is in agreement with other published studies; however, the faecal calprotectin upper limit of normal calculated for children aged 1-3.9 years was lower than has been observed elsewhere.

Emerging Biomarkers for the Diagnosis and Monitoring of Inflammatory Bowel Diseases

There is currently no single test available to confidently diagnose cases of inflammatory bowel disease (IBD). Physicians rely on a number of diagnostic tools, including clinical evaluation, serum testing, and imaging, which are used on conjunction with endoscopic evaluation. It is often difficult to determine whether patients with abdominal pain and change in bowel habit have functional bowel symptoms or whether they have a true diagnosis of IBD. Even once a diagnosis of IBD has been made, a significant proportion of patients are labeled with the term "indeterminate colitis" where histological sampling cannot confidently subclassify patients as either Crohn's or ulcerative colitis. Colonoscopy is an inconvenient and uncomfortable test for most patients. In addition, it is not without serious risks of perforation, as well as risks which can be associated with sedation and analgesia given during the procedure. The use of biomarkers to aid in the diagnosis, subclassification, and monitoring of IBD is an ever expanding area. In this review, we have concentrated on noninvasive biomarkers of IBD, because these are more acceptable to patients and easier to perform in everyday clinical practice. We will first touch on those biomarkers currently well established and in wide clinical use, such as C-reactive protein, erythrocyte sedimentation rate. Faecal calprotectin and their use in the diagnosis of IBD. Following on, we will review more novel biomarkers and their use in subclassification and monitoring of IBD, including a variety of antibodies, genetics, and microRNAs, as well as touching on metabolomics.

PTH-054 Home-Testing of Faecal Calprotectin Using the IBDoc™ System: A Comparative Pilot Study

Introduction Faecal calprotectin (FCAL) is a useful test for monitoring of inflammatory bowel disease (IBD) activity. Providing a stool sample in person to the hospital laboratory is an anecdotally unpopular method with poor uptake. A new FCAL kit (IBDoc™, Buhlmann Labs AG, Switzerland) enables self-testing using a proprietary collection tube, camera smartphone and app. The aim of this study was to assess patient’s adherence to, and experience of, a testing regimen using IBDoc™, as well as benchmarking the assay to the standard laboratory test. Methods After focussed training, participants were asked to test using IBDoc™ once a month for four months and provide a standard stool sample which was posted to the hospital laboratory overnight and refrigerated on receipt, to be tested with standard ELISA (Buhlmann). The following questionnaires were applied before and after testing: GAD-7 (anxiety), PHQ-9 (depression), IBD-control-8, Multi-dimensional Health Locus of control (MHLC) and Cognitive Behavioural Responses to Symptoms (CBSRQ). Patients were also asked to record their experiences and preferences for testing on a proprietary questionnaire. REC reference 15/WA/0168. Results 54 consecutive patients (Crohn’s: 23, UC: 31, F = 28, mean age 36.0 ± 9.2 yrs) were enrolled. Participants completed a median of 3 tests (0–4) during the study with 19/54 (35%) completing all four set time points and 17/54 (32%) returning no samples, despite active reminders. There was no difference in any of the questionnaire scores between compliant and non-compliant patients. There was moderate correlation of numerical FCAL results between the two testing methods (r = 0.77, 95%CI 0.68–0.84, p Conclusion There was reasonable uptake and adherence to a demanding testing regimen (more frequent testing than might be required in routine clinical care) with 85% of respondents preferring the IBDoc™ test over other methods. The home testing kit results show only moderate correlation to laboratory ELISA. While this is a promising and clearly popular technology, therefore, further studies are warranted to correlate results to clinical outcomes. Disclosure of Interest None Declared

How to use faecal calprotectin in management of paediatric inflammatory bowel disease

Faecal calprotectin (FC) is a neutrophil-derived protein released in stool in response to mucosal inflammation. It is a simple, cheap and non-invasive test with high sensitivity and moderate specificity, which...

Development and Validation of an Inflammatory Bowel DiseasesMonitoring Index for Use With Mobile Health Technologies.

Mobile health technologies are advancing rapidly as smartphone use increases. Patients with inflammatory bowel disease (IBD) might be managed remotely through smartphone applications, but no tools are yet available. We tested the ability of an IBD monitoring tool, which can be used with mobile technologies, to assess disease activity in patients with Crohn's disease (CD) or ulcerative colitis (UC). We performed a prospective observational study to develop and validate a mobile health index for CD and UC, which monitors IBD disease activity using patient-reported outcomes. We collected data from disease-specific questionnaires completed by 110 patients with CD and 109 with UC who visited the University of California, Los Angeles, Center for IBD from May 2013 through January 2014. Patient-reported outcomes were compared with clinical disease activity index scores to identify factors associated with disease activity. Index scores were validated in 301 patients with CD and 265 with UC who visited 3 tertiary IBD referral centers (in California or Europe) from April 2014 through March2015. We assessed activity of CD based on liquid stool frequency, abdominal pain, patient well-being, and patient-assessed disease control, and activity of UC based on stool frequency, abdominal pain, rectal bleeding, and patient-assessed disease control. The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.90 in patients with CD and 0.91 in patients with UC. They identified endoscopic activity with area under the receiver operating characteristic values of 0.63 in patients with CD and 0.82 in patients with UC. Both scoring systems responded to changes in disease activity (P < .003). The intraclass correlation coefficient for test-retest reliability was 0.94 for CD and for UC. We developed and validated a scoring system to monitor disease activity in patients with CD and UC that can be used with mobile technologies. The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.9 or higher in patients with CD or UC, and endoscopic activity in patients with UC but not CD.

Clinical Utility of Biomarkers in IBD.

There is no gold standard for the diagnosis and monitoring of inflammatory bowel diseases (IBD). Biomarkers are useful tools for the management of patients suffering from IBD. However, they should be used only when their additional information is useful for clinical decision-making. In principal, four situations during the management of an individual IBD patient can be discriminated from a clinical standpoint in which biomarkers provide useful information. First, biomarkers may be helpful when the diagnosis of IBD is established and aid in the discrimination between ulcerative colitis (UC) and Crohn's disease (CD) is necessary. Second, biomarkers may be helpful in the prognostic evaluation of IBD severity or disease behavior and for early decisions on the best treatment. The third situation in which biomarkers are useful is the evaluation of disease activity during the disease course, for monitoring and for guidance of ongoing treatment. Finally, the fourth typical situation when biomarkers are of value is after surgery to predict or diagnose a relapse of the disease. From a clinical point of view, it may be more useful to discuss specific biomarkers and their individual value and impact in these four prototypic situations than to sum up advantages and disadvantages for each biomarker isolated from the clinical situation. Therefore, this overview is structured in chapters reflecting those four typical situations during the disease course of IBD patents to critically evaluate the potential and value of each of the biomarkers in the specific situation.

Advantages of Fecal Lactoferrin Measurement during Granulocyte and Monocyte Adsorptive Apheresis Therapy in Ulcerative Colitis

Background: Fecal lactoferrin has been introduced as a useful tool for the diagnosis and monitoring of inflammatory bowel disease (IBD). The aim of this study was to assess if fecal lactoferrin can be employed to predict or estimate the effect of granulocyte and monocyte adsorptive apheresis (GMA) in ulcerative colitis (UC). Methods: This was a prospective study involving 21 patients with UC. Patients with moderately-to-severely active UC who were scheduled to undergo GMA were recruited. Changes in fecal lactoferrin concentration were compared between the GMA-responder and -nonresponder groups. Results: In the GMA-responder group, fecal lactoferrin significantly increased 1 week after the introduction of GMA and then significantly decreased after GMA sessions. Fecal lactoferrin concentrations were significantly higher in the GMA-responder group than in the GMA-nonresponder group at 1 and 2 weeks after the introduction of GMA. Multivariate logistic regression analysis revealed that fecal lactoferrin concentration 1 week after the introduction of GMA was the most contributing factor for the effectiveness of GMA in patients with UC. Conclusions: In the GMA-responder group, fecal lactoferrin concentration significantly increased 1 week after the introduction of GMA. Fecal lactoferrin may be beneficial for predicting clinical response of GMA in patients with UC at an early stage of GMA treatment.

Fecal lactoferrin, a marker of intestinal inflammation in children with inflammatory bowel disease.

The aim of this study was to analyze the usefulness of fecal lactoferrin in the diagnosis and monitoring of inflammatory bowel disease (IBD) in children. The study included 52 children with IBD (24 with Crohn's disease and 28 with ulcerative colitis) aged between 0.92 and 18 years, and 41 IBD-free controls of similar age. Fecal concentration of lactoferrin was determined with a quantitative immunoenzymatic test. Fecal concentration of lactoferrin in children with IBD was significantly higher than in the controls. The cut-off value of fecal lactoferrin concentration optimally distinguishing between the children with IBD and the controls was identified as 13 μg/g. The sensitivity and specificity of this cut-off value equaled 80.7% and 92.7%, respectively, and its positive and negative prognostic values were 96.8% and 63.3%, respectively. Patients diagnosed with moderate Crohn's disease had significantly higher fecal concentrations of lactoferrin than children with the mild or inactive disease. Similarly, children with moderate ulcerative colitis showed significantly higher fecal concentrations of lactoferrin than individuals with the mild condition. No significant relationship was found between the fecal concentration of lactoferrin and the severity of endoscopic lesions. Patients with IBD and a positive result of fecal occult blood test were characterized by significantly higher concentrations of lactoferrin than the individuals with IBD and a negative result of this test. In conclusion, fecal concentration of lactoferrin seems to be a useful parameter for diagnosis and monitoring of IBD in children.

PWE-022 Patient Acceptability Of A Novel, Non-invasive Method Of Colonic Sampling For Biomarker Analysis

IntroductionBiomarker analysis is commonly used for the diagnosis of those presenting with colorectal symptoms and monitoring of inflammatory bowel disease (IBD), but the acceptability of stool sampling is poor. It...

Diagnostic options. Indications and validity

A variety of diagnostic methods provide the necessary rational basis for diagnosis, assessment of disease activity and exclusion of possible complications for patients with inflammatory bowel disease (IBD). Currently, a wide range of diagnostic methods is available and easily accessible. The clinical use of all these different methods is inherently possible. As there is no reference test for either diagnosis or monitoring of IBD, diagnostic techniques must be selected, applied and interpreted in an appropriate clinical context. The objective is to evaluate the clinical, laboratory and imaging techniques including ultrasound and endoscopy in different clinical situations. In addition to clinical parameters, fecal calprotectin and abdominal ultrasound are helpful tools to assess the inflammatory activity. In patients with high inflammatory activity, a routine endoscopy is not beneficial. At best, endoscopy can be performed to document the extent of mucosal inflammation before initiating an intensified immunosuppressive therapy. Knowledge and experience in the management and treatment of IBD complications are critical in providing a rational use of specific diagnostic methods. As a basic principle, the critical evaluation of diagnostic methods in patients with IBD is of great importance. Specific clinical situations require specific diagnostic techniques. Every diagnostic method performed should have a purpose.

Clinical Utility of Fecal Biomarkers for the Diagnosis and Management of Inflammatory Bowel Disease

Diagnosis and monitoring of inflammatory bowel diseases rely on clinical, endoscopic, and radiologic parameters. Inflammatory biomarkers have been investigated as a surrogate marker for endoscopic diagnosis of inflammatory activity. Fecal inflammatory biomarkers such as calprotectin and lactoferrin are direct products of bowel inflammation and provide an accurate and noninvasive diagnostic and monitoring modality for Crohn's disease and ulcerative colitis. This report contains an overview of the currently existing literature pertaining to clinical implications of fecal biomarkers for diagnosis, monitoring, and prediction of outcomes of inflammatory bowel disease.

Serum and urine metabolomic fingerprinting in diagnostics of inflammatory bowel diseases

To evaluate the utility of serum and urine metabolomic analysis in diagnosing and monitoring of inflammatory bowel diseases (IBD). Serum and urine samples were collected from 24 patients with ulcerative colitis (UC), 19 patients with the Crohn's disease (CD) and 17 healthy controls. The activity of UC was assessed with the Simple Clinical Colitis Activity Index, while the activity of CD was determined using the Harvey-Bradshaw Index. The analysis of serum and urine samples was performed using proton nuclear magnetic resonance (NMR) spectroscopy. All spectra were exported to Matlab for preprocessing which resulted in two data matrixes for serum and urine. Prior to the chemometric analysis, both data sets were unit variance scaled. The differences in metabolite fingerprints were assessed using partial least-squares-discriminant analysis (PLS-DA). Receiver operating characteristic curves and area under curves were used to evaluate the quality and prediction performance of the obtained PLS-DA models. Metabolites responsible for separation in models were tested using STATISTICA 10 with the Mann-Whitney-Wilcoxon test and the Student's t test (α = 0.05). The comparison between the group of patients with active IBD and the group with IBD in remission provided good PLS-DA models (P value 0.002 for serum and 0.003 for urine). The metabolites that allowed to distinguish these groups were: N-acetylated compounds and phenylalanine (up-regulated in serum), low-density lipoproteins and very low-density lipoproteins (decreased in serum) as well as glycine (increased in urine) and acetoacetate (decreased in urine). The significant differences in metabolomic profiles were also found between the group of patients with active IBD and healthy control subjects providing the PLS-DA models with a very good separation (P value < 0.001 for serum and 0.003 for urine). The metabolites that were found to be the strongest biomarkers included in this case: leucine, isoleucine, 3-hydroxybutyric acid, N-acetylated compounds, acetoacetate, glycine, phenylalanine and lactate (increased in serum), creatine, dimethyl sulfone, histidine, choline and its derivatives (decreased in serum), as well as citrate, hippurate, trigonelline, taurine, succinate and 2-hydroxyisobutyrate (decreased in urine). No clear separation in PLS-DA models was found between CD and UC patients based on the analysis of serum and urine samples, although one metabolite (formate) in univariate statistical analysis was significantly lower in serum of patients with active CD, and two metabolites (alanine and N-acetylated compounds) were significantly higher in serum of patients with CD when comparing jointly patients in the remission and active phase of the diseases. Contrary to the results obtained from the serum samples, the analysis of urine samples allowed to distinguish patients with IBD in remission from healthy control subjects. The metabolites of importance included in this case up-regulated acetoacetate and down-regulated citrate, hippurate, taurine, succinate, glycine, alanine and formate. NMR-based metabolomic fingerprinting of serum and urine has the potential to be a useful tool in distinguishing patients with active IBD from those in remission.

PTH-161 Outcome of Investigations Performed following a Positive Faecal Calprotectin: a Nine Month Pilot Study from a District General Hospital

IntroductionFaecal calprotectin (FCP) is a neutrophil degradation product used to detect inflammation within the gastrointestinal tract. It can aid differentiation of inflammatory bowel disease (IBD) from functional disorders and in...

Su1174 The Use of Magnetic Resonance Enterography for Diagnosis and Monitoring of Inflammatory Bowel Disease in Clinical Practice

end points were time to surgery and time to tx failure (defined as either need for surgery, biologic therapy stopped or switched due to lack of efficacy or adverse events).Specific MRE findings ; 1. penetrating complications e.g fistulae, 2. Small bowel stenosis (SBS) +/dilatation, 3. Small bowel wall thickening (SBWT) and 4. Relative contrast enhancement (RCE) were then correlated to primary and secondary end points. RESULTS: In total,353 patients were commenced on aTNFtx for CD(182 adalimumab and 171 infliximab).Of these 54 patients had an MRE prior to commencing aTNFtx(23 infliximab;31 adalimumab).The median time from MRE to aTNFtx was 66.2 days (+/58.4). 13/54(24.1%) had surgery within the following year due to tx failure.The proportion of patients with SBS on MRE was significantly greater in those who went on to have surgery within 1 year;10/13 (76.9%) vs 3/ 41(7.3%)respectively (chi-square p,0.001).The frequency of penetrating complications, SBWT and RCE was not significantly different in the group who required early surgery.Time to surgery was significantly shorter in patients with SBS on MRE (log rank p=0.001).34 patients were defined as tx responders vs 20 who experienced tx failure. In a multivariate analysis using cox proportional hazards model, the MRE variables independently associated with time to tx failure were SBS (p ,0.001, hazard ratio 17.9, 95% CI 4.5-71.4) and penetrating complications (p,0.027, hazard ratio 14.5 95% CI 1.4-155.3) . CONCLUSION: The presence of SBS on MRE can help predict need for early surgery and is associated with tx failure in patients who commence aTNFtx. These findings demonstrate the utility of MRE in planning tx and suggest that aTNFtx may be more effective when commenced early in disease course, prior to onset of fibrostenotic or penetrating complications.

Impact on Quality of Life of a Smart Device Mobile Application in Patients with Inflammatory Bowel Disease

Purpose: Web-based monitoring of Inflammatory Bowel Disease (IBD) symptoms has been shown to increase medical adherence. Smart devices (SD), such as smart phones and tablets, allow users to download many health-related apps. The use of SD has increased, and we conducted a randomized trial to determine if a mobile symptom tracking app improves QoL in IBD patients. Methods: Patients with IBD with access to a SD (iPhone®/iPad®/iPod touch® or AndroidTM) were eligible to participate. Patients with Blackberry® smart phones were excluded as the app was not fully optimized for this device. We randomized 90 patients (46 Female and 44 male) ages 20-84 with mild to moderate disease to an experimental group and control group. The experimental group downloaded a free app, GI Monitor (WellApps, New York, NY). Subjects used the app daily to record symptoms, track pain, stress levels, frequency and quality of bowel movements. The control group was educated about websites such as www.ccfa.org for information on IBD. Both groups completed the IBD Questionnaire Survey (IBDQ) at time of enrollment and again at follow-up at 8-38 weeks. Results: The mean disease duration in years was 9.5 ± 7.6 and 11.4 ± 8.5 for the control and experimental groups respectively. Mean time for follow up in person or via phone was 104 days in the control group and 87 days in the experimental group. Mean IBDQ score at times of enrollment and follow up were 158.7 ± 24.7 and 165.9 ± 24.7, and 169.3 ± 29.3 and 172.9 ± 26.8 in the control and experimental groups respectively. The change in pre to post IBDQ score was significant within control group (p<0.03) but not for the experimental group. However, the pre and post IBDQ score was not statistically significant between the two groups. The experimental group did feel that the mobile app was easy to use and subjectively improved their ability to track and correlate symptoms. Conclusion: This is the first study to investigate the use of a smart device in patients with IBD. The data from this small sample did not show comparative improvement in IBDQ scores in the experimental group over the control group. As the study patient population had long-standing IBD with a relatively good QoL at baseline, this may represent a bias toward better QoL among smart device users or improved disease awareness with increasing chronicity of disease. Our study did show that mobile apps can be successfully used in patients with mild to moderate IBD to increase their frequency of clinic visits as their disease status worsens. Further studies investigating long-term use of these tools to monitor symptoms, particularly in newly diagnosed patients, are warranted.

P226 Non-invasive monitoring of inflammatory bowel disease: Need for better tools?

P226 Non-invasive monitoring of inflammatory bowel disease: Need for better tools?

Novel, Objective, Multivariate Biomarkers Composed of Plasma Amino Acid Profiles for the Diagnosis and Assessment of Inflammatory Bowel Disease

BackgroundInflammatory bowel disease (IBD) is a chronic intestinal disorder that is associated with a limited number of clinical biomarkers. In order to facilitate the diagnosis of IBD and assess its disease activity, we investigated the potential of novel multivariate indexes using statistical modeling of plasma amino acid concentrations (aminogram).Methodology and Principal FindingsWe measured fasting plasma aminograms in 387 IBD patients (Crohn's disease (CD), n = 165; ulcerative colitis (UC), n = 222) and 210 healthy controls. Based on Fisher linear classifiers, multivariate indexes were developed from the aminogram in discovery samples (CD, n = 102; UC, n = 102; age and sex-matched healthy controls, n = 102) and internally validated. The indexes were used to discriminate between CD or UC patients and healthy controls, as well as between patients with active disease and those in remission. We assessed index performances using the area under the curve of the receiver operating characteristic (ROC AUC). We observed significant alterations to the plasma aminogram, including histidine and tryptophan. The multivariate indexes established from plasma aminograms were able to distinguish CD or UC patients from healthy controls with ROC AUCs of 0.940 (95% confidence interval (CI): 0.898–0.983) and 0.894 (95%CI: 0.853–0.935), respectively in validation samples (CD, n = 63; UC, n = 120; healthy controls, n = 108). In addition, other indexes appeared to be a measure of disease activity. These indexes distinguished active CD or UC patients from each remission patients with ROC AUCs of 0.894 (95%CI: 0.853–0.935) and 0.849 (95%CI: 0.770–0.928), and correlated with clinical disease activity indexes for CD (rs = 0.592, 95%CI: 0.385–0.742, p<0.001) or UC (rs = 0.598, 95%CI: 0.452–0.713, p<0.001), respectively.Conclusions and SignificanceIn this study, we demonstrated that established multivariate indexes composed of plasma amino acid profiles can serve as novel, non-invasive, objective biomarkers for the diagnosis and monitoring of IBD, providing us with new insights into the pathophysiology of the disease.

Differential Diagnosis of Inflammatory Bowel Disease: What Is the Role of Colonoscopy?

Colonoscopy plays a crucial role in the diagnosis, treatment and follow-up monitoring of inflammatory bowel disease (IBD). Practitioners should be well informed of the colonoscopic findings of IBD to prevent the misdiagnosis, overtreatment or delayed treatment. Distinguishing between Crohn's disease and ulcerative colitis is essential in terms of pharmacological treatment, surgical decision-making, and prognosis. But there are still lesions with difficulty in differentiation that approximately 10% of the patients fall into the category of indeterminate colitis. Efforts are needed to carefully select treatment approach appropriate for each patient by providing a precise diagnosis on the extent and degree of lesions as well as to accurately delineate the lesions to assure that they are compared in subsequent rounds of follow-up monitoring in order to allow redetermination and adjustment of the treatment.

Management of inflammatory bowel disease in pregnancy.

Inflammatory bowel disease (IBD) affects body image, relationships, family planning, fertility and pregnancy outcomes. However, the common misconception that IBD is a contraindication, or serious concern, in pregnancy is essentially a myth. Most patients with IBD can expect to have uneventful pregnancies. We present an overview of the management of IBD during pregnancy, including management in those planning pregnancy, the suitability of relevant medication during pregnancy and breast feeding, investigation and monitoring of IBD during pregnancy, surgical management and considerations relating to delivery. While there are some definite alterations required in the management of IBD during pregnancy, management is essentially unchanged. With close attention to aspects such as nutrition and smoking cessation, and optimal disease control in the run-up to and during pregnancy, we have an opportunity to help our patients with IBD achieve good pregnancy outcomes.