| Invited Lecture(JSGE) |
| Thu. November 21st 16:30 - 17:00 Room 11: Portopia Hotel South Wing Topaz |
Monitoring of IBD treatment response This session has been cancelled due to the speaker's schedule. |
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| Remo Panaccione | |||
| University of Calgary | |||
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| Management of inflammatory Bowel Disease (IBD), has traditionally placed high value on subjective symptom assessment; however, it is increasingly appreciated that patient symptoms and objective parameters of inflammation can be disconnected. Therefore, when monitoring response to treatment it is important to follow objective parameters of disease activity/inflammation. Subsequently, clinical decision-making should be driven by these markers, with the aim of optimizing treatment for tight disease control. Mucosal healing has emerged as an important goal in CD management. However, endoscopy is invasive, costly, time-consuming and disliked by patients; therefore, it is performed only to inform critical treatment decisions. Cross-sectional imaging tools are important in CD for establishing disease severity and extent, as well as ruling out complications. Various cross-sectional imaging tools are available including magnetic resonance imaging (MRI), ultrasonography and computed tomography (CT). MRI is considered one of the reference standards in the diagnostic assessment of CD. Ultrasonography is a relatively accessible tool for an urgent broad assessment of disease activity and for exclusion of complications, with high reproducibility and low inter-observer variability. CT enterography combines CT techniques with oral and intravenous contrast. It has similar advantages to MR enterography; however, ionizing radiation exposure limits its use to emergency situations. Multiple biomarkers that reflect the presence of active inflammation have been identified; however, very few have proven to be clinically useful in IBD. C-reactive protein (CRP), an acute-phase reactant that correlates moderately well with clinical, endoscopic, histologic, and radiographic disease activity, is inexpensive to measure with a readily available blood test. Faecal calprotectin and lactoferrin are heat-stable granulocyte-derived proteins that are relatively inexpensive, non-invasive, and have been studied extensively in IBD. More recently, the CALM study was the first study to show that timely escalation with an anti-tumour necrosis factor therapy on the basis of clinical symptoms combined with biomarkers in patients with early Crohn's disease resulted in better clinical and endoscopic outcomes than symptom-driven decisions alone. Further analyses demonstrated that such a strategy decreased disease flares, hospital admissions, while improving quality of life and work productivity. In ulcerative colitis, in addition to mucosal healing, histological remission is becoming an endpoint of interest. Flexible sigmoidoscopy is easily performed to follow treatment response but more and more fecal calprotectin is playing a prominent role. |
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