Predictors in inflammatory bowel disease: Looking into the magic ball: Session one summary.

Abstract

A diagnosis of inflammatory bowel disease (IBD) has a significant impact on a patient and their family that cannot be understated. The incidence of IBD is increasing worldwide and particularly in the Asia–Pacific region due to a variety of known and unknown factors.1 One of the difficult questions facing a clinician when considering a patient with a new diagnosis of Crohn's disease or ulcerative colitis is their prognosis. This is frequently one of the first questions from a patient. The answer to this question impacts both the patient's expectations of their disease and clinical decision-making. The clinician and patient must balance the need for early aggressive medical management, to avoid disease-related complications, with the risk of over treating patients who would otherwise have a mild disease course, potentially exposing them to an increased risk of treatment-related side effects or complications. Therefore, predicting the course of disease early is of clear importance to the field. From longitudinal experience with newly diagnosed patients, we know that disease course can be quite variable, both for ulcerative colitis and Crohn's disease.2-4 Some patients have a largely quiescent disease course requiring minimal interventions, while others have an aggressive course that can culminate in the need for surgery, hospitalization, and the development of disabling disease. For patients with more significant disease, clinical trials and real-world data support the use of earlier aggressive therapy, for example, with combination immunomodulator and biologic therapy, to prevent disease progression and complications such as need for surgery or disabling disease.5, 6 However, identifying which patients are likely to develop progressive disease, and therefore benefit from aggressive medical therapy, remains a clinical challenge. There has been significant improvement in our understanding of both genetic and environmental factors driving the development of IBD with insights into the pathogenesis of the disease.7, 8 In this session, Miles Parkes discusses the utility of genetic markers and transcriptional profiles of blood lymphocytes, examined with respect to their predictive capacity. There is clear potential for these methods to improve our risk stratification and identify patients who require aggressive therapy. Ashwin Ananthakrishnan reviewed the current data on clinical risk factors and assessed their utility. Clinical predictors including disease location for Crohn's disease, inflammatory burden, and need for steroids remain significant predictors of disease course. Finally, Peter De Cruz examined the utility of predictors of disease behavior in the context of risk assessment in specific clinical scenarios including acute severe colitis and postoperative Crohn's disease, two scenarios where the consequences of incorrect risk assessment can be significant. Overall, the speakers in this session emphasized the utility of using clinical predictors for risk assessment in the IBD setting and demonstrated the promising ongoing research into using genetic and other biomarkers for more precise prediction in the near future. JB has received honorariums and consulting fees from Takeda and Janssen-Cilag.