Abstract
In inflammatory bowel disease (IBD), no single cause initiates or triggers the disease. So far, medical treatment of ulcerative colitis (UC) and Crohn’s disease (CD) has been aimed at decreasing the frequency and intensity of flares and limiting comorbidities and their consequences such as strictures, fistulae or cancer. Life-long therapy is usually required as there is to date no cure for IBD.
The goal in the treatment of IBD is to reach deep remission, meaning long-lasting clinical well-being combined with normal endoscopic (mucosal), biochemical (calprotectin and CRP) and histological findings. This status is currently considered to be necessary to alter disease course in IBD patients. Along with clinical reported outcomes (ClinRO), patient-reported outcome measures (PROMs) are gaining more and more weight in the judgement of remission. PROMs are validated and standardized questionnaires intended for completion by the patient to measure their perceptions of their own health condition or treatment. PROMs are aimed to allow decision-making at the level of individual patients.
As the causes of UC and CD are multifactorial, numerous and varying therapeutic strategies are needed to establish a sufficient treatment regime in IBD. However, as disease and patient expectations change over time, treatment often needs to be modified to meet the treatment goals required to optimize the disease outcome.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bernstein CN (2015) Treatment of IBD: where we are and where we are going. Am J Gastroenterol 110:114–126
Bewtra M, Fairchild AO, Gilroy E, Leiman DA, Kerner C, Johnson FR, Lewis JD (2015) Inflammatory bowel disease patients’ willingness to accept medication risk to avoid future disease relapse. Am J Gastroenterol 110(12):1675–1681
Bryant RV, Winer S, Travis SP, Riddell RH (2014) Systematic review: histological remission in inflammatory bowel disease. Is ‘complete’ remission the new treatment paradigm? An IOIBD initiative. J Crohns Colitis 8(12):1582–1597
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140(6):1785–1794
Doherty G, Katsanos KH, Burisch J, Allez M, Papamichael K, Stallmach A, Mao R, Berset IP, Gisbert JP, Sebastian S, Kierkus J, Lopetuso L, Szymanska E, Louis E (2018) European Crohn’s and Colitis Organisation topical review on treatment withdrawal [‘Exit Strategies’] in inflammatory bowel disease. J Crohns Colitis 12(1):17–31
Kim AH, Roberts C, Feagan BG, Banerjee R, Bemelman W, Bodger K, Derieppe M, Dignass A, Driscoll R, Fitzpatrick R, Gaarentstroom-Lunt J, Higgins PD, Kotze PG, Meissner J, O’Connor M, Ran ZH, Siegel CA, Terry H, van Deen WK, van der Woude CJ, Weaver A, Yang SK, Sands BE, Vermeire S, Travis SP (2018) Developing a standard set of patient-centred outcomes for inflammatory bowel disease - an international, cross-disciplinary consensus. J Crohns Colitis 12:408. https://doi.org/10.1093/ecco-jcc/jjx161 [Epub ahead of print]
Latella G, Papi C (2012) Crucial steps in the natural history of inflammatory bowel disease. World J Gastroenterol 18(29):3790–3799
Peyrin-Biroulet L, Ferrante M, Magro F, Campbell S, Franchimont D, Fidder H, Strid H, Ardizzone S, Veereman-Wauters G, Chevaux JB, Allez M, Danese S, Sturm A, Scientific Committee of the European Crohn’s and Colitis Organization (2011) Results from the 2nd Scientific Workshop of the ECCO. I: impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis 5(5):477–483
Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, D'Haens G, Dotan I, Dubinsky M, Feagan B, Fiorino G, Gearry R, Krishnareddy S, Lakatos PL, Loftus EV Jr, Marteau P, Munkholm P, Murdoch TB, Ordás I, Panaccione R, Riddell RH, Ruel J, Rubin DT, Samaan M, Siegel CA, Silverberg MS, Stoker J, Schreiber S, Travis S, Van Assche G, Danese S, Panes J, Bouguen G, O’Donnell S, Pariente B, Winer S, Hanauer S, Colombel JF (2015) Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 110(9):1324–1338
Pineton de Chambrun G, Blanc P, Peyrin-Biroulet L (2016) Current evidence supporting mucosal healing and deep remission as important treatment goals for inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 10(8):915–927
Rahier JF, Magro F, Abreu C, Armuzzi A, Ben-Horin S, Chowers Y, Cottone M, de Ridder L, Doherty G, Ehehalt R, Esteve M, Katsanos K, Lees CW, Macmahon E, Moreels T, Reinisch W, Tilg H, Tremblay L, Veereman-Wauters G, Viget N, Yazdanpanah Y, Eliakim R, Colombel JF, European Crohn’s and Colitis Organisation (ECCO) (2014) Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 8(6):443–446
Rutgeerts P, Vermeire S, Van Assche G (2007) Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target? Gut 56(4):453–455
Siegel C (2009) Making therapeutic decisions in inflammatory bowel disease: the role of patients. Curr Opin Gastroenterol 25(4):334–338
Vuitton L, Peyrin-Biroulet L, Colombel JF, Pariente B, Pineton de Chambrun G, Walsh AJ, Panes J, Travis SP, Mary JY, Marteau P (2017) Defining endoscopic response and remission in ulcerative colitis clinical trials: an international consensus. Aliment Pharmacol Ther 45(6):801–813
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Sturm, A. (2019). Medical Management 1: General. In: Sturm, A., White, L. (eds) Inflammatory Bowel Disease Nursing Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-75022-4_10
Download citation
DOI: https://doi.org/10.1007/978-3-319-75022-4_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-75021-7
Online ISBN: 978-3-319-75022-4
eBook Packages: MedicineMedicine (R0)