Emerging prognostic markers to determine Crohn's disease natural history and improve management strategies: a review of recent literature.
Because Crohn's disease (CD) is a chronic, incurable condition, patients require life-long therapeutic approaches to initiate and maintain symptom control, improve quality of life, avoid hospitalizations and surgery, and minimize short- and long-term toxicity and complications such as stricturing, fistulae, osteoporosis and associated bony fractures, and linear growth failure in pediatric patients. Many physicians use symptom-based classifications, such as those published in the American College of Gastroenterology Practice Guidelines, to classify disease severity. However, all current classifications for CD focus predominantly on treating the present symptoms and not on the long-term treatment goal of altering the natural history of the disease. If physicians were able to identify disease phenotypes; at diagnosis, they could advise a course of robust intervention or more. conservative therapeutic modalities with a lower risk of toxicity, as appropriate. Over the past several years, much interest has developed in the role of genetic and serologic markers as prognostic tools in CD. With these genetic and serologic data in mind, clinicians have a growing ability to harness laboratory and genetic testing information in order to stratify patients relative to their risk of disease progression from the time of diagnosis, allowing for a more individualized treatment plan for each patient.
Lichtenstein
Gary R
GR
Dr. Lichtenstein serves as Director of the Inflammatory Bowel Disease Program at the Hospital of the University of Pennsylvania and as Professor of Medicine at the University of Pennsylvania School of medicine in Philadelphia, Pennsylvania.