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Journal of Crohn's and Colitis: 9 (5)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Published on behalf of

Implementing changes in clinical practice to improve the management of Crohn's disease

Remo Panaccione , Toshifumi Hibi , Laurent Peyrin-Biroulet , Stefan Schreiber
DOI: http://dx.doi.org/10.1016/S1873-9946(12)60503-0 S235-S242 First published online: 1 February 2012

Abstract

The introduction of anti-tumour necrosis factor therapies has provided highly effective treatments for Crohn's disease, making it possible to significantly improve the prognosis of patients. However, neither conventional non-biological therapies nor anti-tumour necrosis factor therapies are routinely used to optimum effect. There are several reasons for this, including a lack of specific evidence to guide common clinical questions and a lack of clearly defined treatment targets. This paper suggests some simple changes to the management of Crohn's disease that have the potential to significantly improve patient outcomes. A new treatment target, ‘deep remission’, which includes mucosal healing as well as clinical remission, may be the first step in defining the successful treatment of Crohn's disease; early clinical studies have demonstrated that this is a readily achievable target. Initiating appropriate treatment early can increase clinical remission rates, improve steroid sparing, induce mucosal healing and prevent structural bowel damage, whereby reducing the need for hospitalization and surgery. There are also clear indications that modifying treatment based on regular objective assessments of disease activity to provide tight disease control can improve patient outcomes in a similar way to that observed in rheumatoid arthritis. These simple changes to management strategy appear to allow the full potential of available treatments to be realized. Clinical studies to further define optimized treatment strategies for Crohn's disease are underway and will provide future direction.

Keywords
  • Corticosteroids
  • Crohn's disease
  • Immunomodulators
  • Optimized monitoring
  • Treatment optimization
Abbreviations
  • Anti-TNF
  • anti-tumour necrosis factor
  • CD
  • Crohn's disease
  • CDAI
  • Crohn's Disease Activity Index
  • CDEIS
  • Crohn's Disease Endoscopic Index of Severity
  • CRP
  • C-reactive protein
  • DBE
  • double balloon enteroscopy
  • HBI
  • Harvey-Bradshaw index
  • IL
  • interleukin
  • MRI
  • magnetic resonance imaging
  • SES-CD
  • Simple Endoscopic Score for Crohn's Disease
  • TNF
  • tumour necrosis factor

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