Review article: Altering the natural history of Crohn's disease--evidence for and against current therapies.
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TLDR
The natural course of Crohn's disease is characterized by flare‐ups altered with periods of remission, but major advances in treatment options over the past years have made treatment goals more ambitious and modification of the natural course has become the ultimate endpoint.Abstract:
Summary
Background
The natural course of Crohn's disease is characterized by flare-ups altered with periods of remission. The majority of Crohn's disease patients need surgery within 10 years of diagnosis. Major advances in treatment options over the past years have made our treatment goals more ambitious and modification of the natural course has become the ultimate endpoint.
Aim
To review the evidence of existing therapies for Crohn's disease for changing the natural history.
Methods
A Medline search was undertaken by using ‘natural history’, ‘Crohn's disease’, ‘therapy’ (corticosteroids, azathioprine, methotrexate, infliximab and enteral feeding), ‘surgery’, ‘hospitalizations’ and ‘mucosal healing’.
Results
Corticosteroids do not alter the disease course and maintenance therapy with corticosteroids should be avoided given their side effects. The immunomodulators azathioprine and methotrexate heal the mucosa but their onset of action is slow. Infliximab therapy introduces rapid mucosal healing and is associated with decreased hospitalizations and surgical interventions. Despite the fact that immunomodulators and infliximab are effective in maintaining clinical and endoscopic remission, there is little hard evidence at present that these therapies alter the natural history of the disease. The main reason being the fact that these therapies have so far been used only in refractory patients and that early initiation in the right patient is crucial in order to change the disease course.
Conclusion
Prospective studies should validate predictors of complicated disease and randomized studies in high-risk groups should be performed to answer if early introduction of immunomodulators or biological therapies slows down disease progression and alters natural history.read more
Citations
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Epidemiology and Natural History of Inflammatory Bowel Diseases
TL;DR: It has been proposed that only aggressive therapeutic approaches, based on treatment of early recurrent lesions in asymptomatic individuals, have a significant impact on progression of these chronic diseases.
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Guidelines for the management of inflammatory bowel disease in adults
Craig Mowat,Andrew Cole,Al Windsor,Tariq Ahmad,Ian D. Arnott,R Driscoll,Sally G. Mitton,Timothy R. Orchard,Matthew D. Rutter,Lisa Younge,Charlie W. Lees,Gwo-Tzer Ho,Jack Satsangi,Stuart Bloom +13 more
TL;DR: The present document is intended primarily for the use of clinicians in the United Kingdom, and serves to replace the previous BSG guidelines in IBD, while complementing recent consensus statements published by the European Crohn's and Colitis Organisation (ECCO).
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Management of Crohn's Disease in Adults
Gary R. Lichtenstein,Stephen B. Hanauer,Stephen B. Hanauer,Stephen B. Hanauer,William J. Sandborn,William J. Sandborn,William J. Sandborn +6 more
TL;DR: These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and may be updated with pertinent scientific developments at a later time.
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Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn's disease.
F. Schnitzler,Herma H. Fidder,Marc Ferrante,Maja Noman,Ingrid Arijs,Gert Van Assche,Ilse Hoffman,Kristel Van Steen,Severine Vermeire,Paul Rutgeerts +9 more
TL;DR: MH induced by long‐term maintenance IFX treatment is associated with an improved long-term outcome of the disease especially with a lower need for major abdominal surgeries.
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Natural History of Pediatric Crohn's Disease: A Population-Based Cohort Study
Gwenola Vernier–Massouille,Mamadou Balde,Julia Salleron,Dominique Turck,Jean Louis Dupas,Olivier Mouterde,Véronique Merle,Jean Louis Salomez,Julien Branche,Marti R,Eric Lerebours,Antoine Cortot,Corinne Gower–Rousseau,Jean-Frederic Colombel +13 more
TL;DR: Pediatric Crohn's disease was characterized by frequent occurrence, with time, of a severe phenotype with extensive, complicated disease and immunosuppressive therapy may improve the natural history of this disease and decrease the need for performing surgery.
References
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Journal ArticleDOI
Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial
Stephen B. Hanauer,Brian G. Feagan,Gary R. Lichtenstein,Lloyd Mayer,Stefan Schreiber,Jean-Frederic Colombel,Daniel Rachmilewitz,Douglas C. Wolf,Allan Olson,Weihang Bao,Paul Rutgeerts +10 more
TL;DR: Patients with Crohn's disease who respond to an initial dose of infliximab are more likely to be in remission at weeks 30 and 54, to discontinue corticosteroids, and to maintain their response for a longer period of time, if inflIXimab treatment is maintained every 8 weeks.
Journal ArticleDOI
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TL;DR: Patients with fistulizing Crohn's disease who have a response to induction therapy with inflIXimab have an increased likelihood of a sustained response over a 54-week period if infliximab treatment is continued every 8 weeks.
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Predictability of the postoperative course of Crohn's disease
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