John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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What are therapeutic goals for IBD in 2009? Volume 16, special issue 1, Maladie de Crohn : vers une « rémission profonde » en 2009

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Service d’hépato-gastroentérologie, CHU de Nancy-Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France

Crohn’s disease (CD) is a chronic destructive disease for which current therapeutic strategies seem inadequate. Historical therapeutic goals of CD, namely the induction and maintenance of clinical response and remission do not seem to alter its natural history. Currently, the therapeutic objectives of CD converge toward achieving steroid free remission, endoscopic mucosal healing and reduction in the rate of hospitalization and surgery. The early use of azathioprine and/or tumor necrosis factor (TNF) antagonists is a possible therapeutic option and will, in the future, achieve new therapeutic targets such as reducing “bowel damage”, preventing complications (stricture, fistula, and abscess) and maintaining normal gastro-intestinal physiology. Ulcerative colitis (UC) is a disease with variable course exposing a subgroup of patients to colectomy. Historical therapeutic endpoints of UC are represented by the induction and maintenance of clinical remission. The current treatment endpoints for UC include steroids free remission, mucosal healing and reduced rates of hospitalization and surgery. The evolution of therapeutic endpoints of UC will probably focus sustained clinical and endoscopic remissions with reduced risk of dysplasia and colorectal cancer, and maintenance of a normal gastro-intestinal physiology. Although mesalazine remains the frontline treatment of UC, the second-line therapy (azathioprine and/or TNF antagonists) remains to be defined.