Department of Gastroenterology and Inserm TENS U1235, Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
Gastroenterology. 2022 Apr;162(5):1424-1438. doi: 10.1053/j.gastro.2021.09.076. Epub 2022 Jan 4.
Short- and long-term treatment targets in inflammatory bowel diseases (IBDs) evolved during the last decade, shifting from symptom control to endoscopic healing and patient-centered parameters. The STRIDE-II consensus placed these targets on a timeline from initiating treatment and introduced additional targets, normalization of serum and fecal biomarkers, restoration of quality of life, prevention of disability, and, in children, restoration of growth. Transmural healing in Crohn's disease and histologic healing in ulcerative colitis currently serve as adjunct measures to gauge remission depth. However, whether early treatment according to a treat-to-target paradigm affects the natural course of IBD remains unclear, leading to the need for prospective disease-modification trials. The SPIRIT consensus defined the targets for these trials to assess the long-term impact of early treatment on quality of life, disability, disease complications, risk of neoplastic lesions, and mortality. As further data emerge about the risk-benefit balance of aiming toward deeper healing, the targets in treating IBDs may continue to shift.
在过去的十年中，炎症性肠病（IBD）的短期和长期治疗目标发生了变化，从控制症状转变为内镜下愈合和以患者为中心的参数。STRIDE-II 共识将这些目标放在了从开始治疗到引入额外目标的时间线上，包括血清和粪便生物标志物的正常化、生活质量的恢复、残疾的预防，以及在儿童中恢复生长。克罗恩病的黏膜愈合和溃疡性结肠炎的组织学愈合目前作为衡量缓解深度的辅助措施。然而，根据靶向治疗范式进行早期治疗是否会影响 IBD 的自然病程尚不清楚，这导致需要进行前瞻性疾病修正试验。SPIRIT 共识定义了这些试验的目标，以评估早期治疗对生活质量、残疾、疾病并发症、肿瘤病变风险和死亡率的长期影响。随着关于更深层次愈合的风险效益平衡的进一步数据出现，治疗 IBD 的目标可能会继续改变。
