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The potential for disease modification in Crohn's disease

Nature Reviews Gastroenterology & Hepatology volume 7, pages 79–85 (2010)Cite this article

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Abstract

The natural history of Crohn's disease is characterized by progression to complicated and disabling disease, often necessitating surgical interventions. There is either circumstantial or direct evidence to support the disease-modifying potential of several therapeutic agents. Healing of endoscopic lesions is an emerging surrogate marker of disease modification, as mucosal lesions are considered to reflect ongoing inflammation and tissue damage that lead to the formation of fistulas and fibrotic strictures, which are the main indications for surgery. In contrast to systemic steroids, both azathioprine and anti-tumor necrosis factor (TNF) agents have demonstrated the potential of mucosal healing. Prevention of hospitalization and surgery in the short and medium term has been demonstrated for the anti-TNF agents infliximab and adalimumab. The evidence supporting a role for medical therapy in the prevention of fibrotic wall thickening and in the obliteration of fistula tracks is limited and should be the focus of further prospective studies. These studies should validate predictors of complicated disease and randomized studies should be performed in high-risk groups to investigate whether early introduction of immunosuppressive agents or biologic therapies slows down disease progression and alters the natural history of the disease.

Key Points

  • Disease modification in Crohn's disease should be aimed at avoiding the development of complicated disease, which is associated with hospitalization and surgery

  • Endoscopic mucosal healing is currently the best surrogate marker of disease modification and has been observed after treatment with traditional immunosuppressive agents and with anti-tumor necrosis factor (TNF) agents

  • Early, aggressive immunosuppressive therapy with thiopurines and/or anti-TNF agents results in higher rates of clinical remission; the influence of this strategy on the prevention of complicated disease needs to be established

  • Predictors of early complicated disease are still ill-defined and elucidating these predictors would enable the selection of patients for early immunosuppressive therapy

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Figure 1: The proportion of patients with significant endoscopic recurrence after curative ileocolonic resection for ileocecal Crohn's disease.

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Authors and Affiliations

  1. Department of Gastroenterology, University Hospital Leuven, Leuven, 3000, Belgium

    G. Van Assche, Séverine Vermeire & Paul Rutgeerts

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  1. G. Van Assche
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  2. Séverine Vermeire
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Correspondence to G. Van Assche.

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Competing interests

G. Van Assche, S. Vermeire and P. Rutgeerts serve as consultants for Abbott, Merck and Schering-Plough, are members of the speaker bureau for Abbott, Merck, Schering-Plough and UCB and receive research support from Abbott and Centocor.

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Van Assche, G., Vermeire, S. & Rutgeerts, P. The potential for disease modification in Crohn's disease. Nat Rev Gastroenterol Hepatol 7, 79–85 (2010). https://doi.org/10.1038/nrgastro.2009.220

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