Abstract
Background and Aims:Efforts to slow or prevent the progressive course of inflammatory bowel diseases [IBD] include early and intensive monitoring and treatment of patients at higher risk for complications. It is therefore essential to identify high-risk patients – both at diagnosis and throughout disease course.Methods:As a part of an IBD Ahead initiative, we conducted a comprehensive literature review to identify predictors of long-term IBD prognosis and generate draft expert summary statements. Statements were refined at national meetings of IBD experts in 32 countries and were finalized at an international meeting in November 2014.Results:Patients with Crohn’s disease presenting at a young age or with extensive anatomical involvement, deep ulcerations, ileal/ileocolonic involvement, perianal and/or severe rectal disease or penetrating/stenosing behaviour should be regarded as high risk for complications. Patients with ulcerative colitis presenting at young age, with extensive colitis and frequent flare-ups needing steroids or hospitalization present increased risk for colectomy or future hospitalization. Smoking status, concurrent primary sclerosing cholangitis and concurrent infections may impact the course of disease. Current genetic and serological markers lack accuracy for clinical use.Conclusions:Simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications at diagnosis and throughout disease course. However, many of these risk factors have been identified retrospectively and lack validation. Appropriately powered prospective studies are required to inform algorithms that can truly predict the risk for disease progression in the individual patient.
Highlights
Crohn’s disease [CD] and ulcerative colitis [UC] are chronic gastrointestinal inflammatory diseases characterized by disabling bowel symptoms
Question 1: What are the prognostic factors for disease progression – change in disease behaviour [B1 to B2 and B3], need for therapy escalation, perianal disease, bowel damage and disability – in CD?
CD is an inflammatory disease that may affect the entire GI tract, with repeated flares resulting in bowel damage that leads to a complicated disease course and short- and long-term disability
Summary
Crohn’s disease [CD] and ulcerative colitis [UC] are chronic gastrointestinal inflammatory diseases characterized by disabling bowel symptoms. Ongoing inflammation leads to progressive bowel damage and complications, often requiring surgery. These diseases are associated with significant morbidity, resource utilization and costs to society. As these inflammatory bowel diseases [IBD] often present early in life, they can compromise education, career development and family planning. The challenge remains to select the patients who will benefit most from early intensive therapy, while sparing those who will derive minimal benefit from such treatment.[6] The ability to predict specific disease complications such as progression of phenotype from inflammatory to penetrating or fibrostenotic disease, need for surgery or development of dysplasia or cancer would be of particular value, as would being able to identify ‘red flags’ that could alert the clinician to an impending flare or relapse. We present the agreed statements, together with a summary of published evidence, to guide clinicians on the best use of these predictors in the individual patient
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