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Evolving inflammatory bowel disease treatment paradigms: top-down versus step-up
Shane M Devlin1, Remo Panaccione
1Division of Gastroenterology, Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
The Medical Clinics of North America
|December 1, 2009
Summary
Crohn disease and ulcerative colitis are inflammatory bowel diseases (IBD) with overlapping features. New classification approaches and earlier use of advanced therapies like biologics are improving IBD management.
Area of Science:
- Gastroenterology and Immunology
- Inflammatory Bowel Disease (IBD) Research
Background:
- Crohn disease (CD) and ulcerative colitis (UC) are distinct inflammatory bowel diseases with variable clinical presentations.
- Genetic and immunologic insights suggest CD and UC may exist on a disease continuum.
- Current classification and treatment strategies for IBD are evolving.
Purpose of the Study:
- To provide an overview of current therapeutic approaches for CD and UC.
- To discuss evidence supporting paradigm shifts in IBD management.
- To highlight the role of mucosal healing and early intervention with advanced therapies.
Main Methods:
- Review of current literature on CD and UC therapy.
- Analysis of evidence supporting new treatment paradigms.
- Discussion of clinical, molecular, and serologic classification efforts.
Main Results:
- IBD classification is moving towards a continuum model.
- Mucosal healing is an emerging therapeutic endpoint.
- Earlier use of immunosuppressive and biologic agents, especially in CD, is supported by evidence.
Conclusions:
- Refined classification based on clinical, molecular, and serologic profiles is needed.
- Personalized treatment approaches are crucial for optimizing outcomes in IBD.
- The 'top-down' therapy approach, utilizing biologics and immunosuppressants earlier, shows promise, particularly for Crohn disease.
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