February 08, 2012

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Mucosal Healing and Treatment Efficacy in IBD

Gert van Assche, MD, PhD, Séverine Vermeire, MD, PhD, and Paul Rutgeerts, MD

Endoscopy is arguably the gold standard for establishing, with as much certainty as possible, a diagnosis in IBD. However, the role of endoscopy in assessing the efficacy of medical therapy in IBD is more controversial. Improvement of signs and symptoms has been the primary outcome parameter of IBD trials, and endoscopic assessment has often been omitted from the trial design. However, there may be reasons to consider endoscopic evaluation of novel treatment strategies, other than to simply corroborate data on short-term clinical response or induction of remission. Crohn’s disease is frequently associated with complications, and surgery is inevitable in up to 70% of patients. Repeated bowel resections are necessary in 30% of Crohn’s disease patients, carrying an inherent risk of short bowel syndrome. Fulminant and poorly controlled ulcerative colitis (UC) also necessitates total proctocolectomy in many patients. Next to steroid-free clinical remission, avoiding surgery and associated complications may become the ultimate aim for every IBD therapy.

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LATEST ARTICLES

Leading Articles
- Mucosal Healing and Treatment Efficacy in IBD
  
  Gert van Assche, MD, PhD, Séverine Vermeire, MD, PhD, and Paul Rutgeerts, MD
  
  Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium
  
  Mucosal healing has long been incorporated into the assessment of treatment efficacy in ulcerative colitis; however, in Crohn’s disease this concept has only recently emerged after the evaluation of biological therapies in clinical trials. Systemic steroids do not induce mucosal healing in Crohn’s disease, but purine analogues and anti-tumor necrosis factor (anti-TNF) agents do have the potential to heal mucosal ulcerations. Evidence for mucosal healing has now been provided for the anti-TNF agents infliximab, adalimumab, and certolizumab.
- Management of Lack and Loss of Response to Anti-Tumor Necrosis Factor Therapy
  
  Anne Christine W Vos, Herma H Fidder, MD, PhD, Gijs R van den Brink, MD, PhD, and Daniel W Hommes, MD, PhD
  
  Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
  
  The introduction of biologics has proven a significant breakthrough in the treatment of Crohn’s disease. At the present time, three anti-tumor necrosis factor (anti-TNF) agents are approved by the US Food and Drug Administration for the treatment of Crohn’s disease: infliximab, adalimumab, and certolizumab. Although anti-TNF therapy has been widely studied in clinical trials and found to be effective in Crohn’s disease, approximately one-third of patients do not respond to induction therapy, and around one-third of initial responders lose their response after several months of treatment. In this review, factors associated with lack of response (primary non-responders) and loss of response (secondary non-responders) are discussed. Identifying factors associated with lack and/or loss of response could be helpful in the selection of patients who are likely to benefit from anti-TNF therapy.
- Management of Postoperative Crohn’s Disease
  
  Joseph Rodemann, MD, and Miguel Regueiro, MD
  
  Inflammatory Bowel Disease Center and Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  
  The majority of patients with Crohn’s disease require surgery at some point. Postoperative Crohn’s disease recurrence is common after intestinal resection. The optimal management strategy for postoperative recurrence of Crohn’s disease is controversial. In the absence of universally adopted guidelines, clinicians and patients must discuss and balance the risks and benefits of postoperative pharmacotherapy. Those at a low risk of disease recurrence may not require treatment. On the other hand, patients with more aggressive disease and a high risk of recurrence may be best treated early in the postoperative period with an immunomodulator or anti-tumor necrosis factor agent. Ideally, postoperative treatment decisions would be made using predictable, reliable, and reproducible clinical prediction criteria that would guide treatment. This article reviews the data on postoperative Crohn’s disease – including definitions of postoperative recurrence, surveillance of postoperative recurrence, risk factors, and medications for prevention of recurrence.
Clinical Reviews
Meeting Reports
- Digestive Disease Week 2009  (DDW 2009): Key Updates in  IBD Clinical Research
  
  Uma Mahadevan, MD, and Fernando Velayos, MD, MPH
  
  Chicago, IL, USA, 30 May–4 June, 2009
  UCSF Center for Colitis and Crohn’s Disease, San Francisco, CA, USA
  
  Digestive Disease Week (DDW) 2009 featured several important presentations about the optimal medical management of patients with IBD. Novel methods of determining disease activity, safety of medications with respect to impact on colorectal cancer and pregnancy, optimizing efficacy and duration of medical therapy, and effects on outcomes other than clinical remission (e.g. mucosal healing and fistula closure) were all discussed and are summarized below.

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Produced and published by Remedica Medical Education and Publishing Limited.

February 08, 2012

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