Disease monitoring strategies in inflammatory bowel diseases: What do we mean by ‘tight control’?

Abstract

In recent years, there has been a critical change in treatment paradigms in inflammatory bowel diseases (IBD) triggered by the arrival of new effective treatments aiming to prevent disease progression, bowel damage and disability. The insufficiency of symptomatic disease control and the well-known discordance between symptoms and objective measures of disease activity lead to the need of reviewing conventional treatment algorithms and developing new concepts of optimal therapeutic strategy. The treat-to-target strategies, defined by the selecting therapeutic targets in inflammatory bowel disease consensus recommendation, move away from only symptomatic disease control and support targeting composite therapeutic endpoints (clinical and endoscopical remission) and timely assessment. Emerging data suggest that early therapy using a treat-to-target approach and an algorithmic therapy escalation using regular disease monitoring by clinical and biochemical markers (fecal calprotectin and C-reactive protein) leads to improved outcomes. This review aims to present the emerging strategies and supporting evidence in the current therapeutic paradigm of IBD including the concepts of “early intervention”, “treat-to-target” and “tight control” strategies. We also discuss the real-word experience and applicability of these new strategies and give an overview on the future perspectives and areas in need of further research and potential improvement regarding treatment targets and (“tight”) disease monitoring strategies.

Importancia de la prueba de calprotectina fecal en la enfermedad inflamatoria intestinal

“…La CF se utiliza en atención primaria y secundaria en pacientes con síntomas abdominales para ayudar a diferenciar a aquellos con EII de aquellos otros con síndrome de intestino irritable 26,27 . El sangrado gastrointestinal es una fuente potencial de un aumento significativo de la CF; aunque está presente en la sangre, la CF entra en la luz intestinal como parte de un proceso inflamatorio y se ha calculado que requeriría una pérdida de sangre de más de 300 ml/día en un proceso de pancolitis o un cáncer colorrectal para producir una concentración de CF de aproximadamente 150 mg/g.…”

Gastrointestinal Toxicity of Pelvic Radiotherapy: Are We Letting Women Down?

“…Recent advances in the treatment of IBD must therefore also become relevant to clinicians looking after patients with pelvic radiation disease (PRD). Treatment paradigms in IBD now favour an early introduction of effective biological therapies, applying a treat-to-target approach using close monitoring of biomarkers [62]. The main aim of this is not just to control symptoms, but to modify the underlying pathology of the underlying disease, which in turn, induces mucosal and submucosal healing, leading to long-term remission and ensures patient buy-in [63].…”

Which MRI Score and Technique Should Be Used for Assessing Crohn’s Disease Activity?

“…Despite the introduction of these new molecules, a high percentage of patients do not respond to treatments [5]. In this context, the patients' tight monitoring plays a key role in guiding therapeutic decisions, assessing the response to drugs, and predicting the onset of relapses [6]. A colonoscopy is a fundamental procedure for CD assessment as it not only allows for evaluating endoscopic healing but it is also useful for performing biopsies and analyzing the microscopic disease activity [7].…”