Shapiro, Jason M.

Abstract Inflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, are chronic, inflammatory, immune mediated, relapsing-remitting conditions of the gastrointestinal tract with multidimensional and often negative effects on patients’ quality of life. The global burden of IBD is increasing and is forecast to affect 1% of the population in early industrialized nations over the next 10 years. Advances in our understanding of the causes and pathogenesis of IBD in the past three decades have translated into new treatments that modulate the immune inflammatory cascade. Modern goals of treatment are clinical remission through assessment of patient reported outcomes and deep remission defined as mucosal healing on colonoscopy or imaging. Achieving both clinical and deep remission affords patients a better long term prognosis and quality of life. This review summarizes the latest evidence on IBD diagnosis, staging, and prognosis, with a detailed focus on current treatments.

INTRODUCTION: The American Gastroenterological Association (AGA) has compiled risk factors that may be predictive of disease complications in Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to evaluate the performance of the AGA risk factors for risk stratification in UC and CD. METHODS: We included participants of 2 cohorts: the Ocean State Crohn's and Colitis Area Registry cohort and the Mayo Clinic cohort. Baseline clinical risk factors were extracted according to the AGA pathway. Our primary end point was defined as follows: (i) any inflammatory bowel disease related–hospitalization, (ii) any inflammatory bowel disease–related bowel surgery, or (iii) any progression of disease. We analyzed the association of the number of AGA risk factors with our end point. Statistical multivariable modeling was performed with Cox proportional hazards model. RESULTS: A total of 412 patients with CD were included. Comparing ≥3 risk factors with 0–1 risk factor, we found a significantly increased risk of complications in both the Ocean State Crohn's and Colitis Area Registry cohort (hazard ratio [HR] 2.75, 95% confidence interval 1.71–4.41) and Mayo Clinic cohort (HR 2.07, 95% confidence interval 1.11–3.84). Diagnosis at younger age (HR 2.07), perianal disease (HR 1.99), and B2/B3 behavior (HR 1.92) were significantly associated with disease complications. We did not observe a consistent association between number of risk factors nor any specific individual risk factors and risk of disease complications in the 265 patients with UC included. DISCUSSION: We found a significant association between the number of AGA risk factors and the risk of disease complication in CD; this association was not significant in UC. The presence of ≥ 3 risk factors in CD leads to the highest risk of complications. The AGA care pathway is a useful tool to stratify patients who are at higher risk of disease complications in patients with CD.