Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Department of Gastroenterology, Odense University Hospital, Odense, Denmark.
Scand J Gastroenterol. 2022 Mar;57(3):274-281. doi: 10.1080/00365521.2021.2002397. Epub 2021 Nov 13.
Treatment of patients with inflammatory bowel disease (IBD) should aim at achieving mucosal healing. However, monitoring schedules to support this goal remain undefined. We aimed to identify patients' and physicians' preferences regarding monitoring strategy and investigated the feasibility of such a strategy.
Elements considered relevant for monitoring were identified in questionnaire surveys among 1) patients with IBD receiving biologic agents ( = 172) and 2) their physicians ( = 87). Adherence to a monitoring strategy incorporating these elements was investigated in a retrospective cohort of patients with IBD treated with biologic agents ( = 139).
Patients considered blood and stool samples, endoscopies, and magnetic resonance imaging (MRI) to be relevant aspects of monitoring their disease. However, patients also considered stool samples and endoscopies unpleasant. Physicians considered blood samples (99%), medical consultations (99%), fecal calprotectin (85%), endoscopy (78%), and MRI (71%) to be important aspects of IBD monitoring but considered endoscopies and MRI relevant only at clinical signs of relapse. A review of the clinical use of monitoring strategies including the elements identified above revealed high adherence for blood samples and disease activity indices (92%), but low adherence for fecal calprotectin (38%), therapeutic drug monitoring (38%), and endoscopies (32%).
Important tools for evaluating mucosal healing (e.g., endoscopy) were rated highly unpleasant by patients, and physicians found endoscopies/MRI relevant only in case of relapse. These findings were reflected by low rates of adherence to use of these monitoring tools. In defining monitoring schedules to help achieve treatment goals, these important barriers must be addressed.
治疗炎症性肠病（IBD）患者的目标应是实现黏膜愈合。然而，支持这一目标的监测方案仍未确定。我们旨在确定患者和医生对监测策略的偏好，并研究该策略的可行性。
通过问卷调查，确定了接受生物制剂治疗的 IBD 患者（n=172）和他们的医生（n=87）认为与监测相关的要素。在接受生物制剂治疗的 IBD 患者的回顾性队列中（n=139），研究了纳入这些要素的监测策略的依从性。
患者认为血液和粪便样本、内镜检查和磁共振成像（MRI）是监测疾病的相关方面。然而，患者也认为粪便样本和内镜检查令人不快。医生认为血液样本（99%）、医疗咨询（99%）、粪便钙卫蛋白（85%）、内镜检查（78%）和 MRI（71%）是 IBD 监测的重要方面，但仅在疾病复发的临床迹象时才认为内镜检查和 MRI 相关。对包括上述要素在内的监测策略的临床应用进行回顾，发现血液样本和疾病活动指数的依从性较高（92%），但粪便钙卫蛋白（38%）、治疗药物监测（38%）和内镜检查（32%）的依从性较低。
评估黏膜愈合的重要工具（如内镜检查）被患者评为非常不愉快，而医生仅在疾病复发时发现内镜检查/MRI 相关。这些发现反映了这些监测工具的使用依从率较低。在确定有助于实现治疗目标的监测方案时，必须解决这些重要障碍。
