inflammatory bowel disease

How IBD Management Has Changed Over Time

The management of inflammatory bowel disease (IBD) is changing. There is a shift toward clinicians treating patients to achieve deep remission rather than clinical remission of their disease. However, gaps in access to care continue to delay treatment and create challenges in the overall management of the disease.

Jean-Frederic Colombel, MD is the codirector of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai and professor at Icahn School of Medicine at Mount Sinai in New York. Consultant360 caught up with Dr Colombel to talk about what needs to be done to predict and prevent IBD.

Consultant360: How has IBD management changed over time?

Jean-Frederic Colombel: We have been able to help patients achieve clinical remission with new therapeutics and have decreased mortality rates. Now, we are moving beyond clinical remission and aiming to achieve deep remission. We want to challenge the natural history of the disease to decrease the number of surgeries and disabilities related to the disease. It is still not perfect. We are far from achieving 100% deep remission or even histological remission in patients. There are still problems in the management of IBD, which I suspect are associated with delays in care. We need to improve access to care for patients; there is a large gap in care, especially in the United States. We also have to focus on personalizing medicine to improve the results of our therapies and tackling more therapeutic targets. Right now, all of targets are immunological. I believe we need to be much more comprehensive and consider the impact of diet. The hope for the future is to be able to predict and prevent disease.

C360: What is the role of endoscopic healing?

J-FC: In the past, we targeted mainly symptoms to treat IBD, but now we need to go beyond the treatment of symptoms. We need to achieve endoscopic healing, and if possible, go beyond this to histological healing if we want to change the natural history of the disease. If we want to reduce the surgical rates and the disabilities caused by the disease, endoscopic healing needs to be achieved.

C360: Is surgery still an option for patients with IBD?

J-FC: Surgery can still be a good treatment option among patients with limited disease. Generally speaking, we want to decrease the rate of surgery, because this is bowel damage. Reducing the rate of surgery is one of our goals, even though it is still part of the therapeutic armamentarium, especially among patients with limited disease or when the medications are no longer effective.

C360: How can a multidisciplinary approach impact overall management?

J-FC: Multidisciplinary collaboration is absolutely key. It is very important to provide holistic care to patients, not only by doctors, but also by surgeons, dietitians, psychologists, and social workers. They have to work together for the benefit of the patient. Unfortunately, there are few patients who have access to a specialized center with a multidisciplinary team. This is the biggest problem I want to address in the future—the gaps in care between what is done in specialized centers and what is done in the community.

C360: How far away are we from a cure for IBD?

J-FC: We are still far. Cure means no disease and no treatment, and it is a very difficult task. I believe that we can control the disease, especially if we start early treatment. Maybe in the future we will be able to cure IBD by multiplying therapeutic targets. However, right now, the difficulty in curing the disease may be why I believe more in prevention of the disease. This is also a concept that is endorsed by other specialists in other immune‑mediated diseases including diabetes, rheumatoid arthritis, and lupus. Specialists in these areas want to focus on predicting and preventing the disease, rather than a cure.