Korean J Intern Med.  2018 Jan;33(1):28-35. 10.3904/kjim.2017.400.

Changing treatment paradigms for the management of inflammatory bowel disease

• Im JP
• Ye BD
• Kim YS
• Kim JS

• KMID: 2411507
• DOI: http://doi.org/10.3904/kjim.2017.400

Abstract

Inflammatory bowel disease (IBD) is a chronic and progressive inf lammatory condition of the gastrointestinal tract causing bowel damage, hospitalizations, surgeries, and disability. Although there has been much progress in the management of IBD with established and evolving therapies, most current approaches have failed to change the natural course. Therefore, the treatment approach and follow-up of patients with IBD have undergone a significant change. Usage of immunosuppressants and/or biologics early during the course of the disease, known as top-down or accelerated step-up approach, was shown to be superior to conventional management in patients who had been recently diagnosed with IBD. This approach can be applied to selected groups based on prognostic factors to control disease activity and prevent progressive disease. Therapeutic targets have been shifted from clinical remission mainly based on symptoms to objective parameters such as endoscopic healing due to the discrepancies observed between symptoms, objectively evaluated inf lammatory activity, and intestinal damage. The concept of treat-to-target in IBD has been supported by population-based cohort studies, post hoc analysis of clinical trials, and meta-analysis, but more evidence is needed to support this concept to be applied to the clinical practice. In addition, individualized approach with tight monitoring of non-invasive biomarker such as C-reactive protein and fecal calprotectin and drug concentration has shown to improve clinical and endoscopic outcomes. An appropriate de-escalation strategy is considered based on patient demographics, disease features, current disease status, and patients' preferences.

Keyword

Inflammatory bowel diseases; Prognosis; Treat-to-target; Therapeutic drug monitor

MeSH Terms

Biological Products
C-Reactive Protein
Cohort Studies
Demography
Follow-Up Studies
Gastrointestinal Tract
Hospitalization
Humans
Immunosuppressive Agents
Inflammatory Bowel Diseases*
Leukocyte L1 Antigen Complex
Prognosis
Biological Products
C-Reactive Protein
Immunosuppressive Agents
Leukocyte L1 Antigen Complex