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The armamentarium for the treatment of inflammatory bowel disease (IBD) is growing with the introduction of new targeted therapies. Developing precision medicine approaches using our knowledge of IBD genetics is of great interest and importance. To date, research on genomic markers of drug response has largely focused on anti-tumor necrosis factor alpha (TNF) agents. Currently, no genetic markers have been validated for use in clinical practice to guide treatment selection. However, several studies have highlighted promising blood- and tissue-based markers of drug response. In this chapter, we provide an overview of the current evidence for genomic markers of response to biologics and discuss potential future directions for predictive biomarker discovery.

Inflammatory bowel disease (IBD) is a heterogeneous disease with patients experiencing varying disease courses and response to therapy. Developing precision medicine approaches is of great interest and importance to improve care for IBD patients. Recent advances have the potential to change the way clinicians stratify patients and then select the most appropriate treatment based on an individualized assessment of risk of complications and drug response. In this chapter, we provide concluding remarks on the current evidence and potential for genomics in IBD care and future directions to bring precision medicine approaches to the clinic.

Patients with inflammatory bowel disease (IBD) involving the colon are at increased risk of developing colorectal cancer. Surveillance colonoscopy to detect dysplasia and early colorectal cancer is therefore one of the key elements of health care maintenance in IBD patients. In general, patients with left-sided or extensive colitis should have surveillance exams every 1–2 years starting 8 years after diagnosis. Dysplasia surveillance has typically involved taking four-quadrant random biopsies throughout the colon. However, numerous studies have demonstrated that targeted examination using chromoendoscopy (CE) increases the detection of dysplastic lesions compared to standard-definition white-light colonoscopy and is recommended by the SCENIC international consensus statement. CE is an enhanced visualization technique that involves spraying the colon with a contrast dye, typically methylene blue or indigo carmine. It remains to be definitively determined if CE is better than high-definition white-light colonoscopy and if removing lesions detected by CE leads to meaningful changes in long-term management and colorectal cancer risk.