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

J Gastrointestin Liver Dis. 2016 Dec;25(4):465-471. doi: 10.15403/jgld.2014.1121.254.ken.

Abstract

Background and 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.

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use*
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / drug therapy*
  • Crohn Disease / diagnosis
  • Crohn Disease / drug therapy*
  • Endoscopy, Gastrointestinal
  • Endpoint Determination / trends
  • Female
  • Gastroenterologists / trends*
  • Gastrointestinal Agents / therapeutic use*
  • Health Care Surveys
  • Humans
  • Intestinal Mucosa / drug effects*
  • Intestinal Mucosa / pathology
  • Male
  • Netherlands
  • Practice Patterns, Physicians' / trends*
  • Predictive Value of Tests
  • Remission Induction
  • Treatment Outcome
  • Wound Healing / drug effects*

Substances

  • Anti-Inflammatory Agents
  • Gastrointestinal Agents