Changes in Medical Management of Inflammatory Bowel Disease and Reducing Surgical Risk: Investigating Causality...

Background: Inflammatory bowel diseases (IBDs) are chronic progressive conditions, and their management has evolved over time, not only in the number of available medications but also in therapeutic strategies, resulting in a paradigm shift from treat-on-flare to treat-to-target, with the ultimate goal of modifying disease course. Several studies have shown a reduction in the risk of surgery associated with the concomitant increase in anti-tumor necrosis factor α (TNFα) drug prescription, thus inferring a positive impact of anti-TNFα therapy on IBD natural history. However, establishing a causal relationship is complex, as multiple factors influence disease progression. Methods: To investigate this relationship, a narrative review applying the Bradford-Hill criteria to the existing literature has been conducted. Results: The potential causal link between the introduction and increased use of biologic drugs, particularly anti-TNFα agents, and the reduction in surgical risk in patients affected by IBD are critically reviewed. Conclusions: Establishing a direct causal link between increased anti-TNFα prescriptions and long-term outcomes remains a difficult issue. Multiple factors like greater awareness, early diagnosis, multidisciplinary approaches, introduction of guidelines, and ongoing education also contribute to improved prognosis.