Unmet Challenges in Patients with Crohn’s Disease

Abstract

Patients with Crohn’s disease can present with a variety of clinical manifestations; treatment strategies should focus on long-term remission and improvement of quality of life. There is no standardized process of diagnosing, predicting prognosis, and treating the disease. This narrative review was based on a literature search using PubMed, Embase, and Science Direct. Data on unmet challenges in patients with Crohn’s disease were extracted from identified manuscripts. The aim was to discuss present research on standardized processes in the management of patients with Crohn’s disease and to identify the unmet needs in clinical evaluation and treatment approaches. There is no consensus on standardized diagnostic, treatment, and surveillance algorithms, particularly in assessing complications of Crohn’s, such as stricturing disease, intestinal cancer risk, and cutaneous manifestations. Complications and treatment failure rates of conventional, interventional, and surgical therapy place emphasis on the need for standardized treatment algorithms, particularly in the case of acute complications of the disease. Research on standardized clinical approaches, reliable biomarkers for disease diagnosis and therapy monitoring, and new treatment agents is necessary to improve therapy and reduce complications in patients with Crohn’s disease.

The Management of Postoperative Recurrence in Crohn’s Disease

“…The role of immunosuppressive agents and biological therapies in preventing POR requires further investigation, particularly in terms of comparative effectiveness and long-term outcomes. While biologics demonstrate effectiveness, they exhibit high rates of both primary non-response, ranging from 20–40% within the first year of anti-TNF therapy, and secondary loss of response over time [ 34 , 144 ]. Another limitation is the inability of current therapies to reverse established fibrosis [ 145 , 146 ].…”

“…In this constantly evolving context, developing a risk stratification scoring system that encompasses these differences and possesses valid predictive ability is essential [ 34 ]. Riviere et al proposed a new recurrence score accounting for several anatomic locations with revised terminology for endoscopic POR [ 35 ].…”