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Review
. 2015 May 11;22(3):103-111.
doi: 10.1016/j.jpge.2015.03.009. eCollection 2015 May-Jun.

New Trends in Inflammatory Bowel Disease

Carolina Palmela  1 , Joana Torres  1 , Marilia Cravo  1
Affiliations
Review

New Trends in Inflammatory Bowel Disease

Carolina Palmela et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disease of the gastrointestinal (GI) tract. In the past decade a shift in the treatment paradigm of IBD has ensued. The availability of drugs capable of inducing mucosal healing, combined with the recognition that IBD is not an intermittent disease, but rather a progressive one causing bowel damage and disability, led us to a more stringent strategy. Tailored therapy with more aggressive treatment in high-risk patients, treating beyond symptoms, intervening early before damage occurs, optimizing therapeutic regimens, and actively pursuing sustained remission and sustained control of inflammation are strategies that are slowly being incorporated in our clinical practice. Furthermore, new drugs targeting different immunological pathways, such as vedolizumab, have recently been approved and therefore more therapeutic resources for patients failing anti-tumour necrosis factor alpha (anti-TNFα) agents will be available. The future years look promising for IBD. Hopefully the new trends in IBD management, combined with new drugs, will make possible to change the course of disease and provide better therapy and quality of life for patients suffering from this disabling disease.

A doença inflamatória intestinal (DII) é uma doença idiopática crónica e incapacitante do trato gastrointestinal. Na última década tem-se assistido a uma modificação nas estratégias de abordagem e tratamento do doente com DII. O desenvolvimento de fármacos potentes com capacidade de induzir a cicatrização da mucosa, aliado ao reconhecimento do carácter progressivo da doença, com dano intestinal irreversível e compromisso da qualidade de vida, conduziu à adoção de estratégias mais rigorosas. Tem-se assistido à incorporação de novas estratégias na prática clínica atual, tais como terapêutica individualizada mais agressiva em doentes com mau prognóstico mais precocemente, uso de outros objetivos terapêuticos para além da remissão sintomática, intervenção precoce para evitar o desenvolvimento de dano intestinal irreversível, optimização da terapêutica com objetivo de alcançar a remissão sustentada e o controlo da inflamação. Adicionalmente, a aprovação de novos fármacos com ação em vias imunológicas alternativas, como o vedolizumab, permitirá alargar o espetro terapêutico no doente não respondedor a agentes anti-factor de necrose tumoral alfa.O futuro parece promissor na área da DII. É expectável que as novas estratégias de abordagem do doente com DII, aliadas ao desenvolvimento de novos fármacos, permitam alterar o curso natural da doença, evitando o dano intestinal irreversível e possibilitando a melhoria da qualidade de vida destes doentes.

Keywords: Antibodies, Monoclonal; Colitis, Ulcerative; Crohn Disease; Drug Monitoring; Inflammatory Bowel Diseases; Molecular Targeted Therapy.

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Figures

Figure 1
Figure 1
New trends in IBD: (1) utilization of prognostic factors at diagnosis; (2) the use of a “treat-to-target” strategy and new endpoints in patient management; and (3) new drugs, therapeutic drug monitoring and therapy de-escalation.
See this image and copyright information in PMC

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