Approach to the management of recently diagnosed inflammatory bowel disease patients: a user’s guide for adult and pediatric gastroenterologists.
Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic, progressive, immune-mediated disease of adults and children that has no cure. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. In children, IBD can also result in growth impairment and pubertal delays. IBD is highly heterogenous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Delay in IBD diagnosis, especially in CD, is common and associated with adverse outcomes. Early diagnosis and prompt institution of treatment are the cornerstones for improving outcomes and maximizing health. Early diagnosis requires a low threshold of suspicion and red flags to guide early specialist referral at the primary provider level. While the armamentarium of IBD medications is growing, many patients will not respond to treatment and the selection of first line therapy is critical. Risk stratification of disease severity, based on clinical, demographic and serological markers, can help guide selection of first-line therapy. Clinical decision support tools, genomics and other biomarkers of response to therapy and risk of adverse events are the future of personalized medicine. After starting appropriate therapy, it is important to confirm remission using objective end-points (treat-to-target) with continued control of inflammation with adjustment of therapy using surrogate biomarkers (tight control). Last, IBD therapy extends far beyond medications, and other aspects of the overall health and well-being of the patient are critical. These include preventive health, nutrition, psycho-behavioral support, addressing patients’ concerns around complementary therapy and medication adherence, prevention of disability, and ensuring open communication.
Authors: Manasi Agrawal, Elizabeth A Spencer, Jean-Frederic Colombel, Ryan C Ungaro