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Article 8, 4/2016


Treatment Targets in Inflammatory Bowel Disease: Current Status in Daily Practice

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Tessa E.H. Römkens1,2, Kim Gijsbers1, Wietske Kievit3, Frank Hoentjen1, Joost P.H. Drenth11

1) Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen;
2) Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s Hertogenbosch;
3) Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.254.ken

Background & Aims: Recently, treatment goals in inflammatory bowel disease (IBD) in clinical trials have shifted from mainly symptom-based to more mucosa-driven. Real world data on treatment priorities are lacking. We aimed to investigate the current practice and most commonly used definitions of IBD treatment targets among Dutch gastroenterologists.

Methods: Dutch gastroenterologists were asked to participate in a computer-based nation-wide survey. We asked questions on demographics, opinion and current practice regarding IBD treatment targets.

Results: Twenty-four percent (134/556) of the respondents completed the survey. For both Crohn’s disease (CD) (47.3%, 61/129) and ulcerative colitis (UC)(45%, 58/129) the main treatment goal was to achieve and maintain deep remission, defined as clinical, biochemical and endoscopic remission. Seventy-six percent of the participants use mucosal healing (MH) as a potential treatment target for IBD, whereas 22.6% use histological remission. There is no single definition for MH in IBD. The majority use Mayo score ≤ 1 in UC (52%) and ‘macroscopic normal mucosa’ in CD (66%).

Conclusion: More stringent and mucosa-driven treatment targets as ‘deep remission’ and ‘mucosal healing’ have found traction in clinical practice. The most commonly used definition for MH in routine practice is endoscopic MAYO score ≤ 1 in UC and ‘macroscopic normal mucosa’ in CD.

Key words: Inflammatory bowel disease – mucosal healing – treatment goals – deep remission – ulcerative colitis – Crohn‘s disease.

Abbreviations: CD: Crohn’s disease; CDEIS: Crohn‘s Disease Endoscopic Index of Severity; IBD: Inflammatory Bowel Disease; IBDU: IBD unclassified; IOIBD: International Organization for the Study of Inflammatory Bowel Diseases; MH: Mucosal healing; MMH: Microscopic mucosal healing; PROMS: Patient reported outcome measures; SES-CD: Simple endoscopic score for Crohn’s disease; UC: ulcerative colitis; UCEIS: Ulcerative Colitis Endoscopic Index of Severity.