Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2019; 25(41): 6172-6189
Published online Nov 7, 2019. doi: 10.3748/wjg.v25.i41.6172
Disease monitoring strategies in inflammatory bowel diseases: What do we mean by “tight control”?
Lorant Gonczi, Talat Bessissow, Peter Laszlo Lakatos
Lorant Gonczi, Peter Laszlo Lakatos, First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
Talat Bessissow, Peter Laszlo Lakatos, Division of Gastroenterology, McGill University Health Centre, Montreal H3G 1A4, Quebec, Canada
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Bessissow T reviewed and language edited the submitted version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Peter Laszlo Lakatos, DSc, FRCP (C), MD, Full Professor, Staff Physician, Division of Gastroenterology, McGill University Health Centre, 1650 Cedar Avenue, Montreal H3G 1A4, Quebec, Canada.
Telephone: +1-514-9341934 Fax: +1-514-9344452
Received: September 8, 2019
Peer-review started: September 8, 2019
First decision: September 19, 2019
Revised: September 26, 2019
Accepted: October 30, 2019
Article in press: October 30, 2019
Published online: November 7, 2019

In recent years, there has been a critical change in treatment paradigms in inflammatory bowel diseases (IBD) triggered by the arrival of new effective treatments aiming to prevent disease progression, bowel damage and disability. The insufficiency of symptomatic disease control and the well-known discordance between symptoms and objective measures of disease activity lead to the need of reviewing conventional treatment algorithms and developing new concepts of optimal therapeutic strategy. The treat-to-target strategies, defined by the selecting therapeutic targets in inflammatory bowel disease consensus recommendation, move away from only symptomatic disease control and support targeting composite therapeutic endpoints (clinical and endoscopical remission) and timely assessment. Emerging data suggest that early therapy using a treat-to-target approach and an algorithmic therapy escalation using regular disease monitoring by clinical and biochemical markers (fecal calprotectin and C-reactive protein) leads to improved outcomes. This review aims to present the emerging strategies and supporting evidence in the current therapeutic paradigm of IBD including the concepts of “early intervention”, “treat-to-target” and “tight control” strategies. We also discuss the real-word experience and applicability of these new strategies and give an overview on the future perspectives and areas in need of further research and potential improvement regarding treatment targets and (“tight”) disease monitoring strategies.

Keywords: Crohn’s disease, Ulcerative colitis, Treat-to-target, Tight control, Monitorting, Biomarker

Core tip: Inflammatory bowel diseases are chronic, progressive, immune-mediated disorders leading to disability and cumulative intestinal damage. There has been a major change in treatment paradigms favouring an early introduction of highly effective therapies, applying a treat-to-target approach to target composite clinical and endoscopical therapeutic endpoints and using close monitoring of objective markers of inflammation (with clinical, endoscopical and biomarker assessment) to direct therapeutic decisions until these goals are reached. Although several data support the benefit of ‘treat-to-target’ and “tight control” strategies so far, these approaches require further validation assessing long-term outcomes and more precise definition of therapeutic targets (for both endoscopic and biomarker monitoring).