Established Management Paradigms in IBD: Treatment Targets and Therapeutic Tools

Inflammatory bowel disease affects 1.6 million Americans. Although there are prevailing guidelines for the management of patients with ulcerative colitis (UC) and Crohn’s disease, controversy exists in certain aspects regarding the best management of patients, in particular when clinical practice has advanced beyond standard guidelines. For UC, controversies include the goal of therapy in terms of mucosal healing (vs. clinical remission). In Crohn’s disease, the concept of healing as a treatment goal is more widely accepted. This study focuses and expands on areas that are not clearly delineated in current guidelines, including the role of prognostication, to determine patient treatment paradigms and the opportunity for a more individualized approach that can inform the selection of immunosuppressant or biologic therapy, with an emphasis on how to optimize therapy.