Preventing Collateral Damage in the Inflammatory Bowel Disease Patient: Using Disease Assessment and Prognostic Factors to Optimise Clinical Outcomes

Inflammatory bowel diseases (IBDs) are chronic disabling conditions. Despite the benefits of anti-tumour necrosis factor-α agents in improving quality of life and reducing the need for surgery in many patients, only one-third achieve clinical remission after 1 year of treatment. It is important that treatments go beyond just the alleviation of symptoms, and help to achieve mucosal healing and deep remission.1 The symposium reviewed the natural course of IBD and discussed how focussing management strategies away from simple symptomatic control towards maintaining mucosal healing can significantly improve the quality of life and wider clinical outcomes of patients with IBD. However, this shift in approach requires the redefining of disease severity to highlight the importance of inflammation control and mucosal healing in preventing long-term damage and disability. Dr Peyrin-Biroulet opened the sessions by reviewing how the Randomised Evaluation of an Algorithm for Crohn’s Treatment (REACT) study has enhanced the understanding of the natural history of IBD, and how complete mucosal healing provides the best outcomes in IBD.2 Dr Colombel highlighted that uncontrolled inflammation in IBD can lead to poor outcomes, and how simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications both at diagnosis and throughout the disease course. Dr Ghosh discussed the importance of defining disease severity in IBD and reinforced that while symptoms related to disease activity are a component of overall disease severity, many factors need to be considered to understand the total impact on a patient’s quality of life.