Treat-to-target approach in the management of inflammatory Bowel disease

F, Paulina Nuñez; Mahadevan, Uma; Quera, Rodrigo; Bay, Constanza; Ibáñez, Patricio

doi:10.1016/j.gastrohep.2020.06.032

Cited by 14 publications

(5 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early recognition of inflammatory activity, prompt intervention, along with tight monitoring constitute the cornerstones of the treat-to-target approach in ulcerative colitis (UC)[ 1 , 2 ]. Recently, the Therapeutic Goals Consensus in Inflammatory Bowel Disease (STRIDE-II) has highlighted that achieving mucosa healing in the rectum and colon is the long-term goal for patients with UC (Figure 1 )[ 2 ].…”

Section: To the Editormentioning

confidence: 99%

Are we ready to use new endoscopic scores for ulcerative colitis?

Quera,

Núñez F

2024

World J Gastroenterol

Self Cite

View full text Add to dashboard Cite

For ulcerative colitis (UC), the variability in inflammatory activity along the colon poses a challenge in management. The focus on achieving endoscopic healing in UC is evident, where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation. However, these indices primarily consider the most severely affected region. Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting (TIGER) score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore (MES). Despite recommendation, certain aspects warrant further investigation. Fecal calprotectin, an intermediate target, correlates with TIGER and should be explored. Determining TIGER scores defining endoscopic remission and response, evaluating agreement with histological activity, and assessing inter-endoscopist agreement for TIGER require scrutiny. Exploring the correlation between TIGER and intestinal ultrasound, akin to MES, adds value.

show abstract

Section: To the Editormentioning

confidence: 99%

Are we ready to use new endoscopic scores for ulcerative colitis?

Quera,

Núñez F

2024

World J Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…[ 6 ] Furthermore, the management of IBD has evolved from sole clinical symptoms-driven intensification of therapy to ‘treat-to-target’ strategy, as the use of biologic immunosuppressive agents in asymptomatic patients with active disease based on endoscopy and disease biomarkers can prevent disease progression. [ 7 ] With the presence of contradictory clinical symptoms and endoscopic findings demonstrated in some patients,[ 8 ] an adjunctive use of IUS to determine the activity of disease in IBD might be helpful in guiding a proper optimal management.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of intestinal ultrasound for disease activity assessment in patients with inflammatory bowel disease: A cross-sectional study at a tertiary centre in Malaysia

Nawawi¹,

Lim²,

Ali³

et al. 2023

Saudi Journal of Gastroenterology

View full text Add to dashboard Cite

Background: The use of intestinal ultrasound (IUS) in the management of inflammatory bowel disease (IBD) is emerging. We aim to determine the performance of IUS in the assessment of disease activity in IBD. Methods: This is a prospective cross-sectional study of IUS performed on IBD patients in a tertiary centre. IUS parameters including intestinal wall thickness, loss of wall stratification, mesenteric fibrofatty proliferation, and increased vascularity were compared with endoscopic and clinical activity indices. Results: Among the 51 patients, 58.8% were male, with a mean age of 41 years. Fifty-seven percent had underlying ulcerative colitis with mean disease duration of 8.4 years. Against ileocolonoscopy, IUS had a sensitivity of 67% (95% confidence interval (CI): 41-86) for detecting endoscopically active disease. It had high specificity of 97% (95% CI: 82-99) with positive and negative predictive values of 92% and 84%, respectively. Against clinical activity index, IUS had a sensitivity of 70% (95% CI: 35-92) and specificity of 85% (95% CI: 70-94) for detecting moderate to severe disease. Among individual IUS parameters, presence of bowel wall thickening (>3 mm) had the highest sensitivity (72%) for detecting endoscopically active disease. For per-bowel segment analysis, IUS (bowel wall thickening) was able to achieve 100% sensitivity and 95% specificity when examining the transverse colon. Conclusions: IUS has moderate sensitivity with excellent specificity in detecting active disease in IBD. IUS is most sensitive in detecting a disease at transverse colon. IUS can be employed as an adjunct in the assessment of IBD.

show abstract

“…The relapse rate of CD 1 year after diagnosis is approximately 40%-50% for all treatment modalities combined (8). A majority of patients respond to corticosteroids at the time of diagnosis, but 1 year after diagnosis, in those treated with corticosteroids, the relapse rate is approximately 40%-60% (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

et al. 2022

View full text Add to dashboard Cite

INTRODUCTION:There is currently little knowledge on factors associated with the relapse of Crohn's disease (CD) in children. The aims of this study were to describe the risk factors associated with relapse in pediatric CD and the changes in the relapse rate over the past decade.METHODS:Patients younger than 18 years and diagnosed between 2009 and 2019 were included in this retrospective cohort study. Clinical, endoscopic, histological, and laboratory data, as well as induction and maintenance treatments, were collected from the medical records. Survival analyses and Cox regression models were used to assess the impact of these risk factors on relapse.RESULTS:Six hundred thirty-nine patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of the patients diagnosed between 2009 and 2014 relapsed as compared with 49.1% of the patients diagnosed between 2015 and 2019 (P < 0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio [aHR] = 1.52, P = 0.0007), exposure to oral 5-ASA (aHR = 1.44, P = 0.04), use of immunomodulatory agents compared with tumor necrosis factor-alpha inhibitors (methotrexate aHR = 1.73, P = 0.003; thiopurines aHR = 1.63, P = 0.002), presence of granulomas (aHR = 1.34, P = 0.02) and increased eosinophils on intestinal biopsies (aHR = 1.36, P = 0.02), high levels of C-reactive protein (aHR = 1.01, P < 0.0001) and fecal calprotectin (aHR = 1.08, P < 0.0001), and low serum infliximab levels (aHR = 2.32, P = 0.001).DISCUSSION:Relapse of pediatric CD has decreased in the past decade. The risk of relapse is significantly associated with clinical, endoscopic, histological, and laboratory variables and treatment strategies.

show abstract

Treat-to-target approach in the management of inflammatory Bowel disease

Cited by 14 publications

References 71 publications

Are we ready to use new endoscopic scores for ulcerative colitis?

Are we ready to use new endoscopic scores for ulcerative colitis?

Evaluation of intestinal ultrasound for disease activity assessment in patients with inflammatory bowel disease: A cross-sectional study at a tertiary centre in Malaysia

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

Contact Info

Product

Resources

About