Korean J Gastroenterol.  2015 May;65(5):268-272. 10.4166/kjg.2015.65.5.268.

Changing Paradigm in the Management of Inflammatory Bowel Disease

• Jang BI

• KMID: 2373222
• DOI: http://doi.org/10.4166/kjg.2015.65.5.268

Abstract

Inflammatory bowel disease (IBD) is a chronic progressive idiopathic inflammatory disorder that involves the digestive tract from the mouth to the anus. Over the past decades, many therapeutic strategies have been developed to manage IBD, but therapeutic strategies based only on relief of clinical symptoms have not changed the natural history of this disease entity. This underlines the importance of understanding the natural history of IBD itself. When we look at the natural history of Crohn's disease (CD), it first begins with inflammation of the intestinal mucosa and this inflammatory reaction proceeds to stenosing or penetrating reaction if not adequately controlled. However, it takes a considerable amount of time before mucosal inflammation proceeds to stenosis of the intestinal lumen or penetration into the adjacent bowel. Therefore, it can be expected that if proper care is given during that period, progression of CD to such a complicated disease could be prevented. Even though the concept of mucosal healing was introduced in the early 1990s, no correlation could be observed between healing of mucosal lesions and relief of clinical symptoms. However, the introduction of biologic agents targeting tumor necrosis factor has changed the way to treat IBD that is refractory to standard medications and has allowed us to aim for a new therapeutic goal, 'deep remission'. Further advances in biologic agents have provided highly effective treatments for IBD, making deep remission a realistic goal. Whether IBD patients may benefit by experiencing a 'deep' remission beyond the control of clinical symptoms need to be evaluated in further investigation. Nevertheless, it can be anticipated that attaining deep remission might ultimately have an impact on important outcomes such as the need for surgery and the quality of life.

Keyword

Inflammatory bowel diseases; Crohn disease

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Antibodies, Monoclonal/therapeutic use
Colitis, Ulcerative/drug therapy/metabolism/pathology
Crohn Disease/drug therapy/metabolism/pathology
Humans
Inflammatory Bowel Diseases/drug therapy/metabolism/*pathology
Intestinal Mucosa/metabolism/pathology
Mesalamine/therapeutic use
Tumor Necrosis Factor-alpha/immunology/metabolism
Anti-Inflammatory Agents, Non-Steroidal
Antibodies, Monoclonal
Mesalamine
Tumor Necrosis Factor-alpha

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