In a special issue of Gastroenterology, an introductory article for the issue discusses the past and future of inflammatory bowel diseases (IBDs) as we enter an era of disease modification.
IBDs, including Crohn disease and ulcerative colitis, are life-long diseases of the gastrointestinal tract that affect both the gut and extra-intestinal manifestations, which lead to chronic, life-limiting symptoms and disability. In recent years, the incidence of IBDs has been increasing worldwide and is projected to reach 1% during this decade.
The unpredictability of the disease course and outcomes of IBDs are hallmarks of the diseases. It is difficult to predict whether a patient will have indolent or more aggressive disease, making clinical decisions about which therapy will yield the best response a challenge for clinicians.
Between the 1800s and 1900s, there was no known treatment for IBD and many patients were left with disability and morbidity. Between the 1900s and 1980s, clinicians established that corticosteroids and aminosalicylates were effective treatment options and, during this time, standard surgical approaches for complication management were formulated.
In 1987, the first placebo-controlled trials began to be conducted, leading to evidence-based treatment options available for patients with IBD. In addition, the first genetic markers for IBD were identified, opening additional strategies for designing drug targets.
More recently, much emphasis has been placed on new disease management approaches, such as “treat-to-target” or “precision” medicine.
The focus of this special issue of Gastroenterology is the next era for IBD ¾ the era of disease modification. The goal of disease modifying approaches are to change the trajectory of IBD, maintain a patient’s function, and sustain quality of life.
To achieve this, boundaries must be pushed, and much research is needed to focus on identifying gaps in care, determining whether IBD should be reclassified, optimizing disease monitoring, finding more effective biomarkers, and reevaluating treatment goals.
Hart A, Rubin DT. Entering the era of disease modification in inflammatory bowel disease. Gastroenterology. Published online February 11, 2022. doi:10.1053/j.gastro.2022.02.013