Clinical, serological and genetic predictors of inflammatory bowel disease course
Open Access
- 1 January 2012
- journal article
- review article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 18 (29), 3806-13
- https://doi.org/10.3748/wjg.v18.i29.3806
Abstract
International audiencePatients with extensive or complicated Crohn's disease (CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines. In patients with localized and uncomplicated CD at diagnosis, early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact. In this context, there is a need for predictors of benign or unfavourable subsequent clinical course, in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions. At diagnosis, an age below 40 years, the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course. The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts. Consequently, the use of these predictors can be integrated into the elements that influence individual decisions. In the CD postoperative context, keeping smoking and history of prior resection are the strongest predictors of disease symptomatic recurrence. However, these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice. In ulcerative colitis (UC), extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease, and also with long-term colectomy and colorectal inflammation-associated colorectal cancer. In patients with extensive UC at diagnosis, a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered. At the moment, no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identifiedKeywords
This publication has 64 references indexed in Scilit:
- Postoperative recurrent luminal Crohnʼs Disease: A systematic reviewInflammatory Bowel Diseases, 2012
- Genetics and pathogenesis of inflammatory bowel diseaseNature, 2011
- Clinical Outcome of Crohn's Disease: Analysis According to the Vienna Classification and Clinical ActivityInflammatory Bowel Diseases, 2001
- High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosisGut, 2001
- Pediatric “PSC-IBD”: A Descriptive Report of Associated Inflammatory Bowel Disease Among Pediatric Patients With PSCJournal of Pediatric Gastroenterology and Nutrition, 2001
- Impact of cessation of smoking on the course of ulcerative colitisThe American Journal of Gastroenterology, 2001
- Marker antibody expression stratifies Crohn's disease into immunologically homogeneous subgroups with distinct clinical characteristicsGut, 2000
- Smoking and disease recurrence after operation for Crohn's diseaseBritish Journal of Surgery, 2000
- Disease Activity Courses in a Regional Cohort of Crohn's Disease PatientsScandinavian Journal of Gastroenterology, 1995
- Published by Baishideng Publishing Group Inc.