Inflammatory bowel diseases (IBD) are chronic inflammations of the gastrointestinal tract of which the causes are not fully clear, although research in the past years has provided more insight. The two major types of IBD are Crohn's disease en colitis ulcerosa. IBD patients show chronic abdominal pain, (bloody) diarrhoea, weight loss and sometimes anaemia. A majority of the patients with IBD will need to undergo surgical interventions and to be on medication for years. Both types of disease are characterized by active periods of inflammation alternated with periods of remission. Apart from inflammation in the gastrointestinal tract, patients often also show inflammation of for example the skin, eyes, joints and biliary tract. Crohn's disease may also co-occur with fistulas. Fistulas are abnormal communications of the intestines with for instance the skin next to the anus. Often patients are confronted with IBD at a relatively early age, which may cause educational delay and job absenteeism or incapacity for work at a later age. The number of new cases has sharply risen in the Netherlands in the past few years, like in other European countries.

Researchers' current opinion is that the disease is caused by a combination of hereditary and environmental factors. Medical treatment consists of anti-inflammatory agents. The patients' quality of life could be much improved by better individual targeting of medical treatment. More insight in the aetiology of the disease, the effectiveness of drugs, and the cost-effectiveness of the treatment will improve the care for all IBD patients and restrict the economic loss (job absenteeism and cost of treatment) in the future.

Inflammatory bowel diseases outpatient clinic
A major spearhead for the IBD-group in Erasmus MC is excellent patient care for this often disabling, chronic disease. This is why a dedicated IBD outpatient clinic (5 half-days a week) aimed at high-quality care is available. It is staffed by a team of two senior physicians of the department of Gastroenterology and Hepatology, two gastroenterologists in training (supervised by the senior physicians) and two IBD-nurses. As these patients regularly have to undergo examinations of the intestinal tract, these examinations usually are performed within the IBD-endoscopy program under supervision of the IBD-senior physicians.

Apart from the care for adult patients, the IBD-group participates in the transition program for adolescents (14-18 years) suffering from IBD (de Luchtbrug - overhead bridge). In cooperation with the paediatric gastroenterology department the adolescents in this program are prepared for transition to adult care.

IBD-patients information day
Every year the department organizes a public information day, in close partnership with the Dutch Crohn and Colitis Ulcerosa Association (CCUVN) and the hospitals in the region. Ongoing scientific research Erasmus MC IBD-group:

Apart from industry-initiated, large-scale studies into the effectiveness of new drugs, self-initiated research is aimed at good stratification of patients into risk groups. This is aimed at better prediction of the disease course in an individual patient and establishing the effect of specific medication in this individual patient. The final goal is to enhance the patient's quality of life, which in general will be lower than normal, as best as possible

Drug research

• SONIC: effect of treatment with infliximab or axathioprine or a combination of these drugs in patients with Crohn's disease.
• ENCORE: safety registration infliximab in Crohn's disease.
• AST: effect of bile acid salts binders on healing of fistulas in Crohn's disease.
• Golimumab: humane anti-TNF for the treatment of colitis ulcerosa.
• Abatacept: medication for the treatment of Crohn's disease.
• ITF: oral anti-TNF for the treatment of Crohn's disease.
• P04808: safety registration infliximab in colitis ulcerosa.
• COMPASS: certoluzimab in Crohn's disease.

Self-initiated drug research
ADAFI study: effect of combination of anti-TNF with ciproxin on the healing of fistulas in Crohn's disease.

Other drug research
Effect of the development of antibodies against infliximab and against adalimumab on the effectiveness of adalimumab.
Effect of anti-TNF/ MTX/azathioprine on the effectiveness of glucocorticoids.

Quality of life studies

• Study into therapy compliance of IBD patients.
• Study into the patient's own opinion on IBD-specific problems.
• Study into the development and treatment of fatigue in Crohn's disease.

Endoscopy and IBD
Double-balloon enteroscopy (DBE) in Crohn's disease: frequency of IBD localized in the small bowel.

The following studies are being conducted in the laboratory of the department of Gastroenterology and Hepatology
Carcinogenesis and IBD
- study into predictive methods in IBD-related CRC.
- study into the influence of bile acid salts on the development of CRC in IBD.

Woman and IBD: this study aims to assess possible differences between males and females with IBD with regard to quality of life, hereditariness and the influence of hormones on disease activity. This project also pays special attention to fertility and pregnancy issues.

Molecular immunological mechanisms of IBD: including the role of apoptosis of the immune-competent cells in the IBD pathogenesis and its clinical application for diagnostic procedures and therapy.

Cooperation in the Netherlands
A unique initiative was launched in the Netherlands, in which gastroenterologists of the eight university centres with specific interest in IBD joined forces in the fields of research, education and patient information; it was named ‘Initiative on Crohn Colitis' (ICC). One of the results of this cooperation is the so-called Parelsnoer (Pearl chain) project. This project aims to build a Biobank infrastructure providing for the registration of data on the clinical course, as well as the storage and analysis of body material, in a standardized manner for eight patient groups in all centres.

Several ICC-initiated studies

• Crohn and Bone: effect of treatment with alendronate on the bone mass of patients with Crohn's disease.
• Anti-CD3 therapy: medication for the treatment of patients with severely active Crohn's disease.
• Azathioprine and its influence on pregnancy and child.
• Intestinal cancer in patients with inflammatory bowel disease.

Symposium
In September 2008 the ICC held its second symposium, dedicated to fertility, pregnancy and lactation.

Patient information
Close ties are maintained with the Crohn Colitis Ulcerosa Association (CCUVN) in the Netherlands. An information day for IBD-patients is organized yearly, in cooperation with the CCUVN.

PhD thesis defence

• Diagnosis and therapy of anal sphincter disorders. RL West, 01-12-2004.
• Composition and activity of gut microbiotica in inflammatory bowel disease. M van Nuenen, 18-11-2005.
• Treatment of mucosal inflammatory disorders. JM van Dieren, 18-04-2007.