Predictive factors of the course and therapeutic response in inflammatory bowel disease

摘要

The vast majority of patients with inflammatory bowel disease (IBD) have a clinical course that is characterized by periods of well-being interrupted by acute exacerbation (clinical relapse). It is usually a simple matter of treating the mild to moderately severe clinical relapses of disease by conventional means (corticosteroids, sulphasalazine or the 5-aminosalicyIic acid (5-ASA) preparations, antibiotics, etc.) and preventing relapses with long-term administration of sulphasalazine, 5-ASA and/or azathioprine (or 6-mercaptopurine), Within this group of patients it is clear that the clinical relapse is currently largely unpredictable, it interferes significantly with the daily activities and patients cannot reliably plan future activities. Additionally frequent treatment courses are associated with significant side-effects, especially if patients become steroid-dependent. It is an ambitious aim to design a test that can reliably identify those patients at greatest risk for clinical relapse in order that targeted treatment can be given at an asymptomatic stage. However, if such a test existed it would simplify therapeutic clinical trials. If successful this might shift the emphasis of treatment from symptom-based acute relapse to prevention by treatment of asymptomatic patients at risk of relapse.