Evolving Treatment Algorithms in Crohn's Disease.
Crohn's disease (CD) is a chronic, disabling and destructive condition. Half of patients will develop some bowel damage (stricture, fistula and/or abscess). Current therapeutic strategies failed to alter its natural history.



We explore in a review article the evolution of CD treatment over a quarter of a century from a linear sequence of treatment intensification to a complex algorithm focused on individualized patient care by looking beyond symptoms. Specifically we focus on evolving concepts in assessing disease severity, selecting rigorous treatment end-targets, initiating an effective therapeutic therapy, and managing secondary loss of response.



A tight monitoring of objective signs of inflammation and a treat-to-target approach are probably the only way to change patients' life and disease course. We now seek to optimize our therapeutic tools according to patient profile, disease phenotype and the unique pharmacodynamics that ensues.



Standardizing the clinical practice of gastroenteroogists with the most current treatment algorithm may minimize disease related complications while favouring patient's quality of life.
Department of gastroenterology, University of Sherbrooke, Hopital Charles-Lemoyne, Montreal, Canada.
Andrew
A
Wisniewski
IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Silvio
S
Danese
Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Universite de Lorraine, Vandoeuvre, France.
Laurent
L
Peyrin-Biroulet
D000465:Algorithms; D003424:Crohn Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D010641:Phenotype; D011788:Quality of Life; D012720:Severity of Illness Index
D007155:Immunologic Factors
Crohn's disease; anti-tnf; drug monitoring; mucosal healing; treat to target; treatment algorithm.