Hépato-Gastro & Oncologie Digestive


Benefit-to-risk ratio in IBD therapeutic strategies Volume 16, special issue 1, Maladie de Crohn : vers une « rémission profonde » en 2009


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Centre Hospitalier Universitaire de Nice, Pôle Digestif, Service de Gastro-entérologie et de Nutrition Clinique, Hôpital de l’Archet 2, 06202 Nice Cedex 03, France, Université de Nice-Sophia-Antipolis, Faculté de Médecine, Nice, F-06107, France

Chronic idiopathic inflammatory bowel diseases are characterised by the presence in the gut of extensive areas of inflammation, leading to a remitting and relapsing course that progresses to complications and surgery in the majority of patients. Current clinical practice is a stepwise approach with goals aimed at inducing and maintaining clinical remission. However, recent studies and expert opinions have begun to question these traditional treatment goals and approaches. Using agressive therapies earlier may alter the natural history and prevent irreversible damage to the gut. With the use of concomitant immunosuppressives and biologics, evolving data raise concerns for an increase in adverse events. The purpose of this review is to assess the benefit-to-risk ratio of our treatment approach on an evidence-based medicine.