The burden of bowel preparation is substantial. An informed personalized choice of preparation may improve adherence, tolerability and colon cleansing.

No abstract

Despite current guidelines, the optimal treatment of patients with inflammatory bowel disease (IBD) remains challenging. The available medications are not without risk and there is not a single correct treatment regimen for every patient. Personalizing treatment and selecting the most appropriate therapy is crucial for optimal response, remission, quality of life, and healthcare utilization. Biologics, especially anti-tumor necrosis factor-α medications, are widely used in the induction and maintenance of disease remission in patients with IBD. Similarly, immunomodulators, including thiopurines and methotrexate, are traditionally popular for the maintenance of remission. In this manuscript, we review the use of biologic monotherapy vs. combination therapy with immunomodulators for the treatment of ulcerative colitis and Crohn’s disease. We examine overall remission, immunogenicity and adverse effects, mainly serious infections and malignancy, in an effort to help guide treatment decisions and weigh the risks and benefits of biologic monotherapy vs. combination therapy.

Colonoscopy is a powerful screening method for colorectal cancer. However, colonoscopy performance is highly variable and quality indicators are needed to ensure delivery of high-quality healthcare. A multi-society task force has recently identified three priority quality indicators in colonoscopy: adenoma detection rate, cecal intubation rate, and adherence to surveillance guidelines. The best-studied quality indicator is the adenoma detection rate, which is inversely correlated to the risk of interval colorectal cancer. Other important quality determinants include colonoscopy withdrawal time and the bowel preparation quality. It is important to note that these quality metrics are interrelated and optimization at every level is necessary for any high-quality colorectal cancer screening and prevention program.