Russell Cohen, MD, on Defining the Target to Treat in IBD

Russell Cohen, MD, reviews his presentation from the virtual Advances in Inflammatory Bowel Disease 2020 regional meeting July 25 on defining the target to treat in inflammatory bowel disease. 

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Russell Cohen, MD, is director of the Inflammatory Bowel Disease Center at UChicago Medicine.


This is Dr Russell Cohen from the University of Chicago. Thank you for joining me today. I hope that you've found my presentation on defining the treat‑to‑target that we use in IBD relevant to your practice today.

It is very important for us to realize that the old way that we were treating IBD was actually not getting the job done. Patients with Crohn's disease routinely had Crohn's disease come back after surgery or after getting them well. Patients with ulcerative colitis also constantly relapsed and up to a third of them required surgery.

More recently, through international organizations and other guidelines, we've set up parameters that are objective measurements of disease. Mostly the endoscopic ones, but also some of the biomarkers can be helpful, such as CRP and fecal calprotectin; looking for histologic healing seems to add to the endoscopic benefit seen with complete endoscopic treatment. Even radiographic evaluations for patients with Crohn's disease that may be out of the reach of the standard endoscope or colonoscope can be helpful in you objectively determining whether your patients have indeed met remission.

The studies have repeatedly shown that patients with Crohn's or colitis who feel well are only halfway there. Those who feel well but have objective healing of the mucosa endoscopically, histologically, with the addition of helping the biomarkers, particularly fecal calprotectin normalize, have better outcomes than patients who don't.

They're much less likely to end up in surgery, less likely end up back on steroids with progression of disease and we even think there may be a benefit in decreasing colon cancer risk in those patients who have colonic inflammation.

So treat to target for your patients. That's how we treat in 2020 and beyond. Thanks for joining me again in Chicago. Looking forward to seeing you again live someday.


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