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Exploring the controversial themes of IBD*

INTRODUCTION The symposium Exploring the Controversial Themes of IBD was held on October 6, 2008 in Orlando, Florida. During this program, nationally renowned leaders in the field of inflammatory bowel disease (IBD) management debated and discussed a number of controversial questions relevant to practicing gastroenterologists. Important questions addressed by the faculty included the use of 5-aminosalicylates (5-ASAs) in Crohn’s disease (CD), the role of 5-ASAs in maintaining remission in ulcerative colitis (UC), the use of medications during pregnancy, the role of topdown strategies in IBD, and the minimum standards for colonoscopic surveillance in UC. By summarizing the discussion from this symposium, this supplement aims to increase clinician awareness of the continually evolving data in CD and UC and thus enable them to provide optimal care for patients with these lifelong, potentially debilitating diseases. WHAT ARE THE MINIMUM STANDARDS FOR SURVEILLANCE IN ULCERATIVE COLITIS? Given the well-recognized increased risk of colorectal dysplasia and cancer (CRC) in patients with UC, aggressive prevention strategies are warranted. Although we believe that colonoscopic surveillance is a critically important strategy for detecting and preventing CRC in patients with long-standing UC, evidence supporting the efficacy of surveillance in reducing CRC-related mortality is somewhat limited. A population-based, nested, case-control study of 142 UC patients from Sweden demonstrated a relative risk reduction in cancer-related deaths of 71% in patients who had undergone 1 previous surveillance colonoscopy and 78% in those who had undergone 2 or more procedures. In a study of 188 patients with UC-related cancer matched with controls for extent and duration of disease, surveillance colonoscopy was associated with an incremental stepwise protection against CRC (Fig. 1). Compared with patients who had not undergone colonoscopy, those who