Advances in the diagnosis and management of inflammatory bowel disease: challenges and uncertainties.
Over the past two decades, several advances have been made in the management of patients with inflammatory bowel disease (IBD) from both evaluative and therapeutic perspectives. This review discusses the medical advancements that have recently been made as the standard of care for managing patients with ulcerative colitis (UC) and Crohn's Disease (CD) and to identify the challenges associated with implementing their use in clinical practice. A comprehensive literature search of the major databases (PubMed and Embase) was conducted for all recent scientific papers (1990-2013) giving the recent updates on the management of IBD and the data were extracted. The reported advancements in managing IBD range from diagnostic and evaluative tools, such as genetic tests, biochemical surrogate markers of activity, endoscopic techniques, and radiological modalities, to therapeutic advances, which encompass medical, endoscopic, and surgical interventions. There are limited studies addressing the cost-effectiveness and the impact that these advances have had on medical practice. The majority of the advances developed for managing IBD, while considered instrumental by some IBD experts in improving patient care, have questionable applications due to constraints of cost, lack of availability, and most importantly, insufficient evidence that supports their role in improving important long-term health-related outcomes.
Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada, .
Mahmoud
M
Mosli
Mohammad
M
Al Beshir
Bandar
B
Al-Judaibi
Turki
T
Al-Ameel
Abdulaziz
A
Saleem
Talat
T
Bessissow
Subrata
S
Ghosh
Majid
M
Almadi
D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D053704:Capsule Endoscopy; D002464:Cell Migration Inhibition / Q000187:drug effects; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D039021:Colonic Pouches; D003424:Crohn Disease / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D003937:Diagnosis, Differential; D005243:Feces / Q000737:chemistry; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging; D007781:Lactoferrin / Q000032:analysis; D008279:Magnetic Resonance Imaging; D000069442:Natalizumab; D012680:Sensitivity and Specificity; D059039:Standard of Care; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers; D000069442:Natalizumab; D007781:Lactoferrin