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Caitlin Whyte (Host): Inflammatory bowel disease or IBD can be a frustrating diagnosis. But today we are talking about all of the advances made in therapeutic and surgical options in IBD at USF with two of our experts, Dr. Jorge Marcet, the Director of Colon and Rectal Surgery at the USF Morsani College of Medicine and Dr. Jennifer Seminerio, the Director of Inflammatory Bowel Disease, also at the USF Morsani College of Medicine.

Welcome to the Tampa Generally Speaking podcast, a go-to listening location for specialized physician to physician content and a valuable learning tool for world-class healthcare. I'm your host, Caitlin Whyte. So, starting off our conversation today, I'll turn to you, Dr. Marcet. What new therapies are coming out in the next few years and what are their mechanisms of action when it comes to IBD?

Jorge Marcet MD (Guest): IBD is an idiopathic, incurable, chronic inflammatory bowel disease of the gastrointestinal tract. And it affects over a million people in the United States and for an unknown reason, it continues to increase in incidence. Recently, monoclonal antibodies have become the cornerstone of medical therapy for moderate to severe disease. Surgical advances in inflammatory bowel disease include efforts at applying minimally invasive surgical techniques. So, these techniques include laparoscopy and then more recently robotic surgery, as well as single port laparoscopy. And trans-anal minimally invasive techniques. These are all techniques that use keyhole surgery. So, minimal incisions to do the operations that are necessary, when medical management fails.

Host: And Dr. Seminerio, is there data on complimentary therapies and which ones work?

Jennifer Seminerio MD (Guest): Yeah, there's limited data, but there is data on different complimentary therapies. And I think that, you know, the, the way that we try to discuss it with patients is exactly in the manner in which you said it as a complimentary approach to conventional drug therapies versus an alternative approach. But there are certain supplements out there that have some data that is positive in the world of inflammatory bowel disease, specifically supplements such as curcumin or tumeric as well as omega-3 fatty acids. There's some data on traditional Chinese therapies. Again, the data is limited. Different within the, in the Crohn's disease arena versus the ulcerative colitis arena.

But there are certainly studies that show that, that it may be promising. And I think that the important take home within the supplement arena is that you have to know that there's very limited data on side effects because this stuff is not overseen in the same manner in which conventional drug therapies are.

Additionally, we have done some studies looking at therapies such as acupuncture, GI hypnosis, cognitive behavioral therapy, all of which may play a positive role in quality of life improvement scores. And then more recently, we've started to put emphasis into dietary measures. And so we just published our first study in Crohn's disease, looking at the simple carbohydrate diet versus the Mediterranean diet and there's data to show that both of these diets, again may be beneficial in a complimentary approach as well as we still have ongoing studies looking at probiotics and prebiotics with more data in the ulcerative colitis arena, showing positive benefits to things like VSL#3 and Visbiome in comparison to other medications.

Host: Wonderful. So, it sounds like there's some options, but like you said, keep that lack of data for now in mind. Now let's focus on USF. Dr. Marcet. How are surgical outcomes at USF?

Dr. Marcet: So, we believe they're very good. And part of this is because we function as a multidisciplinary team. We have our Inflammatory Bowel Disease Center of Excellence in which we work very closely with Dr. Seminerio and her colleagues in making sure that patients are offered a multidisciplinary approach to. And this is important because although medical therapy is the cornerstone of therapy, the medical therapy is limited by primary and secondary loss of response. And ultimately this leads to surgery for the correction of complications related to the disease complications, such as fistulas, bowel obstruction and sometimes even cancer.

What we've seen over the past decade is that the need for urgent surgery has lessened. However many patients still ultimately require surgery for their condition. And unfortunately, surgery alone is not curative. So, we know the recurrence rates of the disease are high. By one year, there's recurrence up to 70% endoscopic evidence of recurrence and many patients end up having a repeat operation within 10 years.

So the importance here is that the surgeon and the gastroenterologist work together in making sure that the patient is given the optimal therapy, not just the optimal medical therapy, but the optimal surgical therapy, and then the continued lifelong optimal medical therapy, even after surgery. That's the importance of that multidisciplinary approach to care. And as you heard from Dr. Seminerio, it's just, it's not just medical treatment, but it's dietary treatment. It's psychosocial efforts at improving the quality of life of these patients.

Host: Absolutely. So, Dr. Seminerio, can you describe some of the surgical options available for IBD at USF?

Dr. Seminerio: Absolutely. I mean, first and foremost, I think that the surgical options available here are superior to other places because of the relationship that we share with our colorectal colleagues. And this is something that becomes really important to patients in the sense of not only our continuity care conference that we have with them, but the one-on-one conversations that I have with my colleagues in colorectal, that my nurse practitioners have with their nurse practitioners.

And so that patients always feel as though it isn't one doctor versus another and that this is a complete care approach with regards to what decisions we're going to make. And then that way, when we do have discussions about surgical approaches and surgical options, it makes patients feel like this is a continuation of their medical therapy and not a last resort and not a failure on their part or a failure on the medical therapy part. In the arena of Crohn's disease, multiple different options exist. Typically, we strive to remove the least amount of intestine possible because of the fact that Crohn's disease can recur. And we don't want them to end up with situations where they have short gut or longterm complications from multiple surgeries. That being said, from a resection approach, we can do this open when necessary, but our surgeons do this laparoscopically and where they're making minimal incisions and creating minimal scarring internally.

We also have the opportunity to do different procedures in regards to fistulas, fistulectomies when necessary, seton placements, incision and drainage. And then within ulcerative colitis, you tend to be in a different situation wherein if surgery is necessary, you're talking about the removal of the entire colon. And this can be done in a step wise approach with ultimate creation of an ilial anal J pouch anastomosis, or in some patients, the decision is made to do an end ileostomy and a removal of the colon and anus in completion. And so I think that for our patients, one of the things that makes me really happy is that when I do talk to them about these options and when I do discuss with them referral over to our colorectal colleagues, they can feel secure, not only in the sense that I'm going to be in communication, but in the sense that I am sending them over to experts in the inflammatory bowel disease surgical fields, just like I'm an expert in the medical field.

Host: It sounds like you have a lot of good things going on at USF, but as we wrap up here, Dr. Marcet, can you tell us about the future of IBD at USF?

Dr. Marcet: Yeah, I think there's a bright future. Working together, as Dr. Seminerio mentioned in teams is really the best possible care a patient could get. When doctors are communicating together, very often in the same room, and it's not just the gastroenterologist and the colorectal surgeon, but it's the radiologist. It's the pathologist. It's the dietician. It's the entire team that is involved in studying inflammatory bowel disease. And trying to optimize the care for each individual patient. And so by having set up our Center of Excellence, we feel that the care in our greater community will, will markedly improve for patients with inflammatory bowel disease.

There has not been a center of excellence like this in our area. And so we're very excited about it. It is the best approach to caring for patients and because these are complex diseases, they're lifelong diseases; patients have other medical conditions, you know, throughout their, their lives that also need to be addressed, very often in the context of their underlying inflammatory bowel disease.

And so our, our center is, is poised to grow and to provide care in a way that's not existed before in our area. And I think for the betterment of the health of our patients.

Host: Great. Well, doctor, as we come to a close here, Dr. Marcet, is there anything else you'd like to add to this conversation about IBD at USF?

Dr. Marcet: So I think that our doctors are poised to offer patients opinions on management that take into account the total person, the individualized care of that person, and using evidence-based approaches to provide the optimal medical management and surgical management. As well, we're very actively involved in development of new therapies.

We have a strong research group and are involved in numerous clinical trials that are studying upcoming therapies in inflammatory bowel disease. So, even patients for whom they have been failing certain therapies, they may be eligible for a clinical trial for a newer drug in development. Again, it is a Center of Excellence that not only provides complex care, but continuity of care, and also looking at future developmental drugs that are in development for care.

Host: Wonderful. And Dr. Seminerio same question to you. Any final thoughts about the work you're doing at USF?

Dr. Seminerio: Yeah, thank you so much. I think that the thing that I'm most proud of is what we're building. And I think that sometimes the road that you take to get somewhere and, you know, I think when you see what the future holds here in regards to the creation of the IBD Center in and of itself, which will ultimately become a home for IBD patients in this part of Florida to go to where they can get complete care ranging from, as we stated, up to date new novel therapies, state of the art investigational treatment options. And diagnostic testing to get them the best and most accurate data possible, great colorectal surgery treatment options, wound care, dieticians, and, and mental health wellness; all in a center that's dedicated specifically to them.

It makes me really proud of where we'll stand, not only in the greater Florida area, but nationally. And on the personal standpoint, it's one of my goals to make our center one of the top institutions in the country, so that people from all over want to come to USF specifically for their IBD treatment and care. And I'm really proud of the building blocks we've already put in place. And I am so excited for the future and what it holds here.

Host: Absolutely. Well, it sounds like you both are so passionate about the program at USF, and we love to hear it. We so appreciate your time today and the work you're doing in this field. And thank you for listening to the Tampa Generally Speaking podcast, which is available on all major streaming services for free. You can visit tghh.org/cme for other CME opportunities, including live webinars, on demand videos, and local events offered to you by Tampa General Hospital. This has been the Tampa Generally Speaking podcast. I'm your host, Caitlin Whyte. And we hope you join us again next time.