Evolving inflammatory bowel disease treatment paradigms: top-down versus step-up

Gastroenterology Clinics of North America
Shane Devlin, Remo Panaccione

Abstract

Crohn disease (CD) and ulcerative colitis (UC) comprise a group of inflammatory disorders of the gastrointestinal tract that can vary in severity of disease, anatomic extent of inflammation, presence and nature of extraintestinal manifestations, and response to therapeutic approaches. There have been attempts to classify CD based on the location and behavior of disease. Advances in understanding of genetic susceptibility to inflammatory bowel disease (IBD) suggest that CD and UC may represent a continuum of overlapping disorders. This has led to an attempt to classify IBD on clinical, molecular, and serologic grounds. Differences in clinical, genetic, and immunologic profiles may require more targeted, refined treatment approaches to help clinicians make decisions regarding recently introduced biologic agents. This article provides an overview of the current approaches to therapy for CD and UC and focuses on the evidence supporting the rationale for changing paradigms in the management of IBD, including mucosal healing as an end point and earlier use of immunosuppressive and biologic agents, particularly in CD (so-called top-down therapy).

References

Oct 29, 1988·BMJ : British Medical Journal·J MainD Parratt
Feb 1, 1985·Diseases of the Colon and Rectum·N S AmbroseJ E Lennard-Jones
Jun 30, 1994·The New England Journal of Medicine·S LichtigerS Hanauer
Feb 12, 2002·Inflammatory Bowel Diseases·George L ArnoldWilliam J Mook
Jun 6, 2002·Lancet·Stephen B HanauerUNKNOWN ACCENT I Study Group
Jul 20, 2002·Inflammatory Bowel Diseases·Jacques CosnesJean-Pierre Gendre
Aug 14, 1954·British Medical Journal·S C TRUELOVE, L J WITTS
May 1, 2004·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Stephen B Hanauer, Ulf Strömberg
Sep 7, 2005·Gastroenterology·Stefan SchreiberUNKNOWN CDP870 Crohn's Disease Study Group
Dec 13, 2005·The New England Journal of Medicine·Paul RutgeertsJean Frédéric Colombel
Jan 20, 2007·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Gary R LichtensteinWilliam J Sandborn
May 9, 2007·Gastroenterology·Stephan R TarganUNKNOWN International Efficacy of Natalizumab in Crohn's Disease Response and Remission (ENCORE) Trial Group
Aug 8, 2007·Gastroenterology·Kathrine Frey FrøslieUNKNOWN IBSEN Group
Dec 23, 2008·Scandinavian Journal of Gastroenterology·Inger Camilla SolbergUNKNOWN IBSEN Study Group
Dec 27, 2008·Gastroenterology·Miguel RegueiroScott E Plevy
Apr 3, 2009·Inflammatory Bowel Diseases·Fabian SchnitzlerPaul Rutgeerts

❮ Previous
Next ❯

Citations

Nov 8, 2011·Digestive Diseases and Sciences·Jae Jun ParkWon Ho Kim
Apr 14, 2015·Scandinavian Journal of Gastroenterology·Andrew TinsleyThomas A Ullman
Dec 15, 2012·Expert Review of Gastroenterology & Hepatology·Gia M Bradley, Maria Oliva-Hemker
Apr 21, 2010·Expert Opinion on Emerging Drugs·Ulrike Strauch, Jürgen Schölmerich
Aug 23, 2011·Pediatric Clinics of North America·Eva SzigethyAlka Goyal
May 19, 2010·Child and Adolescent Psychiatric Clinics of North America·Eva SzigethyAlka Goyal
Feb 20, 2013·Laboratory Investigation; a Journal of Technical Methods and Pathology·Eoin P CumminsCormac T Taylor

❮ Previous
Next ❯

Related Concepts

Related Feeds

Avian Influenza: Innate Immune Adjuvant (ASM)

Adjuvants systems that are added to vaccines against avian influenza have be explored to enhance the innate immune system response against the virus. Here is the latest research on avian influenza and the innate immune adjuvant.

Avian Influenza: Innate Immune Adjuvant

Adjuvants systems that are added to vaccines against avian influenza have be explored to enhance the innate immune system response against the virus. Here is the latest research on avian influenza and the innate immune adjuvant.

Adhesion Molecules in Health and Disease

Cell adhesion molecules are a subset of cell adhesion proteins located on the cell surface involved in binding with other cells or with the extracellular matrix in the process called cell adhesion. In essence, cell adhesion molecules help cells stick to each other and to their surroundings. Cell adhesion is a crucial component in maintaining tissue structure and function. Discover the latest research on adhesion molecule and their role in health and disease here.

Related Papers

Current Gastroenterology Reports
Morten H Vatn
Nature Reviews. Gastroenterology & Hepatology
Shanika de SilvaRemo Panaccione
Advanced Drug Delivery Reviews
Stefan Wirtz, Markus F Neurath
© 2022 Meta ULC. All rights reserved