Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases.
OBJECTIVE
Efforts to slow or prevent the progressive course of inflammatory bowel diseases [IBD] include early and intensive monitoring and treatment of patients at higher risk for complications. It is therefore essential to identify high-risk patients - both at diagnosis and throughout disease course.


METHODS
As a part of an IBD Ahead initiative, we conducted a comprehensive literature review to identify predictors of long-term IBD prognosis and generate draft expert summary statements. Statements were refined at national meetings of IBD experts in 32 countries and were finalized at an international meeting in November 2014.


RESULTS
Patients with Crohn's disease presenting at a young age or with extensive anatomical involvement, deep ulcerations, ileal/ileocolonic involvement, perianal and/or severe rectal disease or penetrating/stenosing behaviour should be regarded as high risk for complications. Patients with ulcerative colitis presenting at young age, with extensive colitis and frequent flare-ups needing steroids or hospitalization present increased risk for colectomy or future hospitalization. Smoking status, concurrent primary sclerosing cholangitis and concurrent infections may impact the course of disease. Current genetic and serological markers lack accuracy for clinical use.


CONCLUSIONS
Simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications at diagnosis and throughout disease course. However, many of these risk factors have been identified retrospectively and lack validation. Appropriately powered prospective studies are required to inform algorithms that can truly predict the risk for disease progression in the individual patient.
Surgical Department, Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal.|The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Joana
J
Torres
Department of Pathophysiology and Transplantation, Università degli Studi di Milano and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy.
Flavio
F
Caprioli
Division of Gastroenterology, Department of Internal Medicine, School of Medical Sciences, University of Ioannina, Ioannina, Greece.
Konstantinos H
KH
Katsanos
Department of Gastroenterology, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
Triana
T
Lobatón
University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.|Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, UK.
Dejan
D
Micic
Inflammatory Bowel Disease Unit, Potiguar University School of Medicine, Natal, Brazil.
Marco
M
Zerôncio
Division of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
Gert
G
Van Assche
Department of Medicine, University of Cambridge, Cambridge, UK.
James C
JC
Lee
Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, UK.
James O
JO
Lindsay
University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.|Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, UK.
David T
DT
Rubin
Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
Remo
R
Panaccione
The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA jean-frederic.colombel@mssm.edu.
Jean-Frédéric
JF
Colombel
D000328:Adult; D000367:Age Factors; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
Complications; Crohn’s disease; disease progression; prognostic factors; risk factors; ulcerative colitis