Lande Raul, Blumenstein Irina
Dtsch Med Wochenschr. 2025 Apr;150(8):427-432. doi: 10.1055/a-2335-5901. Epub 2025 Mar 31.
Chronic inflammatory bowel diseases (IBD), such as Crohn's disease (MC) and ulcerative colitis (CU), are serious immune-mediated diseases that affect the gastrointestinal tract and represent a considerable burden for patients. In recent decades, the treatment of IBD has shifted from symptomatic control to more precise, long-term goals. Advances in IBD research have led to therapy goals having been redefined and expanded in order to achieve complete inflammation control and prevent complications in the long term.An important component of modern therapeutic approaches is the definition of specific markers that serve as indicators for the achievement of these therapeutic goals. These markers enable objective monitoring of the success of treatment and thus offer a clear approach for controlling the therapy. The present article focuses on the new therapeutic goals in IBD treatment and discusses the role of therapeutic target markers in clinical practice.A central goal in modern IBD therapy is endoscopic healing, i.e. the complete macroscopic healing of the intestinal mucosa. In clinical practice this includes in particular an ulcer-free mucosa. In contrast to clinical remission alone, endoscopic healing provides an objective assessment of the inflammatory state and correlates strongly with an improved long-term prognosis.The histologic remission goes beyond endoscopic healing and aims to endoscopic healing to no longer detect signs of inflammation at the microscopic level. This is particularly relevant as the results show that patients who achieve a complete histological remission have an even lower recurrence rate and better long-term results than those who only achieve a clinical or endoscopic remission.Even though no curative therapy for IBD currently exists, the complete cure remains the ultimate goal of research. In current practice, this goal is still unattainable in current practice, but progress in genetic and immunological research offers hope. In the long term, the aim is to innovative approaches such as gene editing or immunotherapy to cure the disease. This could mean that patients are not only free of symptoms, but also freed from the burden of the disease in the long term.
慢性炎症性肠病(IBD),如克罗恩病(MC)和溃疡性结肠炎(CU),是严重的免疫介导性疾病,会影响胃肠道,给患者带来相当大的负担。近几十年来,IBD的治疗已从症状控制转向更精确的长期目标。IBD研究的进展促使治疗目标得到重新定义和扩展,以便实现完全炎症控制并长期预防并发症。现代治疗方法的一个重要组成部分是定义特定标志物,作为实现这些治疗目标的指标。这些标志物能够客观监测治疗的成功与否,从而为控制治疗提供明确的方法。本文重点关注IBD治疗的新治疗目标,并讨论治疗靶点标志物在临床实践中的作用。现代IBD治疗的一个核心目标是内镜愈合,即肠道黏膜的完全宏观愈合。在临床实践中,这尤其包括无溃疡的黏膜。与单纯的临床缓解不同,内镜愈合提供了对炎症状态的客观评估,并且与改善的长期预后密切相关。组织学缓解超越了内镜愈合,旨在在内镜愈合的基础上,在微观层面不再检测到炎症迹象。这一点尤为重要,因为结果表明,实现完全组织学缓解的患者比仅实现临床或内镜缓解的患者复发率更低,长期效果更好。尽管目前尚无IBD的治愈性疗法,但完全治愈仍然是研究的最终目标。在当前实践中,这一目标目前仍无法实现,但基因和免疫学研究的进展带来了希望。从长远来看,目标是采用基因编辑或免疫疗法等创新方法来治愈该疾病。这可能意味着患者不仅没有症状,而且从长远来看还能摆脱疾病的负担。