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Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User’s Guide for Adult and Pediatric Gastroenterologists
- Source :
- Gastroenterology
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Inflammatory bowel diseases (IBDs), including Crohn’s disease and ulcerative colitis, are chronic, progressive, immune-mediated diseases of adults and children that have no cure. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. In children, IBD can also result in growth impairment and pubertal delays. IBD is highly heterogenous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Delay in IBD diagnosis, especially in Crohn’s disease, is common and associated with adverse outcomes. Early diagnosis and prompt institution of treatment are the cornerstones for improving outcomes and maximizing health. Early diagnosis requires a low threshold of suspicion and red flags to guide early specialist referral at the primary provider level. Although the armamentarium of IBD medications is growing, many patients will not respond to treatment, and the selection of first-line therapy is critical. Risk stratification of disease severity, based on clinical, demographic, and serologic markers, can help guide selection of first-line therapy. Clinical decision support tools, genomics, and other biomarkers of response to therapy and risk of adverse events are the future of personalized medicine. After starting appropriate therapy, it is important to confirm remission using objective end points (treat to target) with continued control of inflammation with adjustment of therapy using surrogate biomarkers (tight control). Lastly, IBD therapy extends far beyond medications, and other aspects of the overall health and wellbeing of the patient are critical. These include preventive health, nutrition, and psychobehavioral support addressing patients’ concerns around complementary therapy and medication adherence, prevention of disability, and ensuring open communication.
- Subjects :
- Adult
0301 basic medicine
medicine.medical_specialty
Disease
Early Therapy
Risk Assessment
Inflammatory bowel disease
Article
Vedolizumab
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Child
Intensive care medicine
Adverse effect
Crohn's disease
Hepatology
business.industry
Age Factors
Gastroenterology
Inflammatory Bowel Diseases
Prognosis
medicine.disease
Ulcerative colitis
digestive system diseases
Infliximab
030104 developmental biology
Disease Progression
030211 gastroenterology & hepatology
business
Biomarkers
medicine.drug
Subjects
Details
- ISSN :
- 00165085
- Volume :
- 161
- Database :
- OpenAIRE
- Journal :
- Gastroenterology
- Accession number :
- edsair.doi.dedup.....32a88db13a758b3dc40f955c8ecf997c