Purnak Tugrul, Ertan Atilla
Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University Texas McGovern Medical School, Houston, TX 77030, USA.
J Clin Med. 2024 Nov 21;13(23):7026. doi: 10.3390/jcm13237026.
Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic and often debilitating condition requiring complex and individualized management. Over the past few decades, advancements in understanding IBD pathophysiology have led to a transformative shift in therapeutic approaches. This article provides a comprehensive overview of the evolution of IBD treatments, from early symptom-focused therapies to modern biologics, small molecule agents, and emerging treatment strategies. We discuss therapeutic goals centered on achieving clinical remission, endoscopic/mucosal healing, and enhancing patient quality of life. Additionally, we explore the rationale for the early and personalized use of biologic therapies in moderate-to-severe cases, review the current FDA-approved agents as of 2024, and highlight the advantages and limitations of these treatments. Special attention is given to the evolving role of novel oral therapies, including Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators, and future new directions. This paper aims to guide clinicians in navigating the expanding therapeutic landscape of IBD, emphasizing patient-centered decision-making and addressing ongoing challenges in achieving optimal disease control.
炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC），是一种慢性且通常使人衰弱的疾病，需要复杂且个性化的管理。在过去几十年里，对IBD病理生理学认识的进步导致了治疗方法的变革性转变。本文全面概述了IBD治疗的演变，从早期以症状为重点的疗法到现代生物制剂、小分子药物以及新兴治疗策略。我们讨论了以实现临床缓解、内镜/黏膜愈合以及提高患者生活质量为中心的治疗目标。此外，我们探讨了在中重度病例中早期和个性化使用生物疗法的基本原理，回顾了截至2024年美国食品药品监督管理局（FDA）批准的药物，并强调了这些治疗方法的优点和局限性。特别关注新型口服疗法的不断演变的作用，包括 Janus激酶抑制剂和鞘氨醇-1-磷酸受体调节剂，以及未来的新方向。本文旨在指导临床医生应对IBD不断扩展的治疗领域，强调以患者为中心的决策制定，并解决在实现最佳疾病控制方面持续存在的挑战。
