Optimising monitoring in the management of Crohn's disease: a physician's perspective

Abstract

Management of Crohn's disease has traditionally placed high value on subjective symptom assessment; however, it is increasingly appreciated that patient symptoms and objective parameters of inflammation can be disconnected. Therefore, strategies that objectively monitor inflammatory activity should be utilised throughout the disease course to optimise patient management. Initially, a thorough assessment of the severity, location and extent of disease is needed to ensure a correct diagnosis, identify any complications, help assess prognosis and select appropriate therapy. During follow-up, clinical decision-making should be driven by disease activity monitoring, with the aim of optimising treatment for tight disease control. However, few data exist to guide the choice of monitoring tools and the frequency of their use. Furthermore, adaption of monitoring strategies for symptomatic, asymptomatic and post-operative patients has not been well defined. The Annual excHangE on the ADvances in Inflammatory Bowel Disease (IBD Ahead) 2011 educational programme, which included approximately 600 gastroenterologists from 36 countries, has developed practice recommendations for the optimal monitoring of Crohn's disease based on evidence and/or expert opinion. These recommendations address the need to incorporate different modalities of disease assessment (symptom and endoscopic assessment, measurement of biomarkers of inflammatory activity and cross-sectional imaging) into robust monitoring. Furthermore, the importance of measuring and recording parameters in a standardised fashion to enable longitudinal evaluation of disease activity is highlighted.

Keywords: Annual excHangE on the ADvances in Inflammatory Bowel Disease; Biomarkers; C-reactive protein; CD; CDAI; CDEIS; CRP; CT; Crohn's Disease Activity Index; Crohn's Disease Endoscopic Index of Severity; Crohn's disease; Diagnosis; Disease activity index; Endoscopy; GI; HBI; Harvey–Bradshaw Index; IBD; IBD Ahead; IBDQ; ISC; Imaging; Inflammatory Bowel Disease Questionnaire; International Steering Committee; MRI; Monitoring; QOL; SBCE; SBFT; SES-CD; Simple Endoscopic Score for Crohn's Disease; TNF; computed tomography; gastrointestinal; inflammatory bowel disease; magnetic resonance imaging; quality of life; small-bowel capsule endoscopy; small-bowel follow-through; tumour necrosis factor.