Advertisement

Disease Modification in Crohn’s Disease

  • Patrick B. Allen
  • Laurent Peyrin-Biroulet
Chapter

Abstract

Crohn’s disease (CD) is a chronic inflammatory disease of the gastrointestinal tract (GIT) that evolves in a relapsing and remitting pattern. CD is a destructive disease that can result in progressive bowel damage and ultimately disability. It mainly affects young adults, causes morbidity, and impacts on quality of life. The majority of patients with CD initially present with an inflammatory phenotype at diagnosis, but over time various complications that result in tissue damage can occur such as strictures, abscesses, and fistulae, which often require surgery. The functional correlate of tissue damage is disability which may develop over time. Current management strategies therefore base their premise on “treating to target” with the aim of achieving deep and prolonged disease remission, thereby preventing tissue damage and disability. The following sections will address the identification and assessment of tissue damage and how we can evaluate disability in CD.

Keywords

Crohn’s disease Inflammatory bowel disease Disability Quality of life Biologics Immunosuppressants Disease modification Treat to target Deep remission 

References

  1. 1.
    Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV, Loftus EV Jr. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010/07/20. 2010;139(4):1147–55.CrossRefGoogle Scholar
  2. 2.
    Pariente B, Cosnes J, Danese S, Sandborn WJ, Lewin M, Fletcher JG, et al. Development of the Crohn’s disease digestive damage score, the Lemann score. Inflamm Bowel Dis [Internet]. 2011/05/12. 2011;17(6):1415–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21560202.
  3. 3.
    Fiorino G, Bonifacio C, Peyrin-Biroulet L, Danese S. Preventing collateral damage in Crohn’s disease: the Lémann index. J Crohns Colitis. 2016;10(4):495–500.CrossRefGoogle Scholar
  4. 4.
    Pariente B, Mary J-Y, Danese S, Chowers Y, De Cruz P, D’Haens G, et al. Development of the Lémann index to assess digestive tract damage in patients with Crohn’s disease. Gastroenterology. 2015;148(1):52–63.e3.CrossRefGoogle Scholar
  5. 5.
    Fiorino G, Morin M, Bonovas S, Bonifacio C, Spinelli A, Germain A, et al. Prevalence of bowel damage assessed by cross-sectional imaging in early Crohn’s disease and its impact on disease outcome. J Crohns Colitis. 2017;11(3):274–80.PubMedGoogle Scholar
  6. 6.
    Fiorino G, Bonifacio C, Allocca M, Repici A, Balzarini L, Malesci A, et al. Bowel damage as assessed by the Lémann index is reversible on anti-TNF therapy for Crohn’s disease. J Crohns Colitis. 2015;9(8):633–9.CrossRefGoogle Scholar
  7. 7.
    https://www.cdc.gov/hrqol/index.htm. Health related quality of life.
  8. 8.
    Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96(3):804–10.CrossRefGoogle Scholar
  9. 9.
    Williet N, Sandborn WJ, Peyrin-Biroulet L. Patient-reported outcomes as primary end points in clinical trials of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2014;12(8):1246–56.e6.CrossRefGoogle Scholar
  10. 10.
    Jelsness-Jørgensen L-P, Bernklev T, Henriksen M, Torp R, Moum BA. Chronic fatigue is associated with impaired health-related quality of life in inflammatory bowel disease. Aliment Pharmacol Ther [Internet]. 2011 [cited 2017 May 18];33(1):106–14. Available from: http://doi.wiley.com/10.1111/j.1365-2036.2010.04498.x.CrossRefGoogle Scholar
  11. 11.
    Romberg-Camps MJL, Bol Y, Dagnelie PC, Hesselink-van de Kruijs MAM, Kester ADM, Engels LGJB, et al. Fatigue and health-related quality of life in inflammatory bowel disease: results from a population-based study in the Netherlands: the IBD-South Limburg cohort. Inflamm Bowel Dis [Internet]. 2010 [cited 2017 May 18];16(12):2137–47. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00054725-201012000-00020.
  12. 12.
    Minderhoud IM, Samsom M, Oldenburg B. Crohn’s disease, fatigue, and infliximab: is there a role for cytokines in the pathogenesis of fatigue? World J Gastroenterol [Internet]. 2007 [cited 2017 May 18];13(14):2089–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17465453.CrossRefGoogle Scholar
  13. 13.
    Graff LA, Vincent N, Walker JR, Clara I, Carr R, Ediger J, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis [Internet]. 2011 [cited 2017 May 18];17(9):1882–9. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00054725-201109000-00006.
  14. 14.
    Vogelaar L, van’t Spijker A, van Tilburg AJP, Kuipers EJ, Timman R, van der Woude CJ. Determinants of fatigue in Crohn’s disease patients. Eur J Gastroenterol Hepatol [Internet]. 2013 [cited 2017 May 18];25(2):246–51. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00042737-201302000-00018.
  15. 15.
    Moser G. Depression and anxiety in inflammatory bowel disease. Gastroenterol Hepatol [Internet]. 2009 [cited 2017 May 18];32 Suppl 2:9–12. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0210570509725993.
  16. 16.
    Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES. Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors. Am J Gastroenterol [Internet]. 2002 [cited 2017 May 18];97(2):389–96. Available from: http://www.nature.com/doifinder/10.1111/j.1572-0241.2002.05475.x.CrossRefGoogle Scholar
  17. 17.
    Siebert U, Wurm J, Gothe RM, Arvandi M, Vavricka SR, von Känel R, et al. Predictors of temporary and permanent work disability in patients with inflammatory bowel disease. Inflamm Bowel Dis [Internet]. 2013 [cited 2017 Jun 7];19(4):847–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23446333.CrossRefGoogle Scholar
  18. 18.
    Høivik ML, Moum B, Solberg IC, Henriksen M, Cvancarova M, Bernklev T, et al. Work disability in inflammatory bowel disease patients 10 years after disease onset: results from the IBSEN Study. Gut [Internet]. 2013 [cited 2017 Jan 9];62(3):368–75. Available from: http://gut.bmj.com/lookup/doi/10.1136/gutjnl-2012-302311.
  19. 19.
    Coenen M, Cieza A, Stamm TA, Amann E, Kollerits B, Stucki G. Validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis from the patient perspective using focus groups. Arthritis Res Ther. 2006;8(4):R84.CrossRefGoogle Scholar
  20. 20.
    Peyrin-Biroulet L, Cieza A, Sandborn WJ, Kostanjsek N, Kamm MA, Hibi T, et al. Disability in inflammatory bowel diseases: developing ICF Core Sets for patients with inflammatory bowel diseases based on the International Classification of Functioning, Disability, and Health. Inflamm Bowel Dis [Internet]. 2009/07/18. 2010;16(1):15–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19610077.CrossRefGoogle Scholar
  21. 21.
    Peyrin-Biroulet L, Cieza A, Sandborn WJ, Coenen M, Chowers Y, Hibi T, et al. Development of the first disability index for inflammatory bowel disease based on the international classification of functioning, disability and health. Gut [Internet]. 2012 [cited 2012 Dec 7];61(2):241–7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3245899&tool=pmcentrez&rendertype=abstract.
  22. 22.
    Gower-Rousseau C, Sarter H, Savoye G, Tavernier N, Fumery M, Sandborn WJ, et al. Validation of the inflammatory bowel disease disability index in a population-based cohort. Gut. 2017;66(4):588–96.CrossRefGoogle Scholar
  23. 23.
    Peyrin-Biroulet L, Gower-Rousseau C. The IBD disability index should become a major secondary endpoint in clinical practice and in clinical trials. J Crohns Colitis [Internet]. 2016 [cited 2017 May 16];10(12):1375–7. Available from: https://academic.oup.com/ecco-jcc/article-lookup/doi/10.1093/ecco-jcc/jjw156.CrossRefGoogle Scholar
  24. 24.
    Disability, poverty and development. World Hosp Health Serv [Internet]. 2002 [cited 2017 May 16];38(1):21–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12221831.
  25. 25.
    Peyrin-Biroulet L, Panés J, Sandborn WJ, Vermeire S, Danese S, Feagan BG, et al. Defining disease severity in inflammatory bowel diseases: current and future directions. Clin Gastroenterol Hepatol [Internet]. 2016 [cited 2017 May 16];14(3):348–354.e17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26071941.
  26. 26.
    Ghosh S, Louis E, Beaugerie L, Bossuyt P, Bouguen G, Bourreille A, et al. Development of the IBD disk: a visual self-administered tool for assessing disability in inflammatory bowel diseases. Inflamm Bowel Dis [Internet]. 2017 [cited 2017 May 15];23(3):333–40. Available from: http://insights.ovid.com/crossref?an=00054725-201703000-00001.CrossRefGoogle Scholar
  27. 27.
    Peyrin-Biroulet L, Reinisch W, Colombel J-F, Mantzaris GJ, Kornbluth A, Diamond R, et al. Clinical disease activity, C-reactive protein normalisation and mucosal healing in Crohn’s disease in the SONIC trial. Gut. 2014;63(1):88–95.CrossRefGoogle Scholar
  28. 28.
    Peyrin-Biroulet L, Ferrante M, Magro F, Campbell S, Franchimont D, Fidder H, et al. Results from the 2nd scientific workshop of the ECCO. I: impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis [Internet]. 2011 [cited 2013 Jan 21];5(5):477–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21939925.CrossRefGoogle Scholar
  29. 29.
    Colombel J-F, Louis E, Peyrin-Biroulet L, Sandborn WJ, Panaccione R. Deep remission: a new concept? Dig Dis. 2012;30(Suppl 3):107–11.CrossRefGoogle Scholar
  30. 30.
    Colombel J, Rutgeerts PJ, Sandborn WJ, Yang M, Camez A, Pollack PF, et al. Adalimumab induces deep remission in patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2014;12(3):414–422.e5.CrossRefGoogle Scholar
  31. 31.
    Colombel JF, Reinisch W, Mantzaris GJ, Kornbluth A, Rutgeerts P, Tang KL, et al. Randomised clinical trial: deep remission in biologic and immunomodulator naïve patients with Crohn’s disease - A SONIC post hoc analysis. Aliment Pharmacol Ther. 2015;41(8):734–46.CrossRefGoogle Scholar
  32. 32.
    Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110(9):1324–38.CrossRefGoogle Scholar
  33. 33.
    Colombel J-F, Narula N, Peyrin-Biroulet L. Management strategies to improve outcomes of patients with inflammatory bowel diseases. Gastroenterology. 2017;152(2):351–361.e5.CrossRefGoogle Scholar
  34. 34.
    Peyrin-Biroulet L. Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs): the missing term in the literature. Am J Gastroenterol. 2013;108(5):859–60.CrossRefGoogle Scholar
  35. 35.
    Cosnes J, Bourrier A, Laharie D, Nahon S, Bouhnik Y, Carbonnel F, et al. Early administration of azathioprine vs conventional management of Crohn’s Disease: a randomized controlled trial. Gastroenterology. 2013;145(4):758–65-5.CrossRefGoogle Scholar
  36. 36.
    Panés J, López-Sanromán A, Bermejo F, García-Sánchez V, Esteve M, Torres Y, et al. Early azathioprine therapy is no more effective than placebo for newly diagnosed Crohn’s disease. Gastroenterology. 2013;145(4):766–74.e1.CrossRefGoogle Scholar
  37. 37.
    Peyrin-Biroulet L, Danese S. Early combined immunosuppression in Crohn’s disease: acting rather than REACTing. Gastroenterology. 2016;150(4):1040–1.CrossRefGoogle Scholar
  38. 38.
    Khanna R, Bressler B, Levesque BG, Zou G, Stitt LW, Greenberg GR, et al. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial. Lancet. 2015;386(10006):1825–34.CrossRefGoogle Scholar
  39. 39.
    Torres J, Caprioli F, Katsanos KH, Lobatón T, Micic D, Zerôncio M, et al. Predicting outcomes to optimize disease management in inflammatory bowel diseases. J Crohns Colitis. 2016;371(9613):660–7.Google Scholar
  40. 40.
    Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: special situations. J Crohns Colitis [Internet]. 2010/12/03. 2010;4(1):63–101. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21122490.
  41. 41.
    Peyrin-Biroulet L, Fiorino G, Buisson A, Danese S. First-line therapy in adult Crohn’s disease: who should receive anti-TNF agents? Nat Rev Gastroenterol Hepatol [Internet]. 2013 [cited 2013 Apr 1]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/23458890.
  42. 42.
    Zallot C, Peyrin-Biroulet L. Clinical risk factors for complicated disease: how reliable are they? Dig Dis [Internet]. 2012 [cited 2013 Jan 21];30 Suppl 3:67–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295694.
  43. 43.
    Torres J, Boyapati RK, Kennedy NA, Louis E, Colombel J-F, Satsangi J. Systematic review of effects of withdrawal of immunomodulators or biologic agents from patients with inflammatory bowel disease. Gastroenterology. 2015;149(7):1716–30.CrossRefGoogle Scholar
  44. 44.
    Siegel CA, Whitman CB, Spiegel BMR, Feagan B, Sands B, Loftus EV, et al. Development of an index to define overall disease severity in IBD. Gut. 2018;67(2):244–54.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Patrick B. Allen
    • 1
    • 2
  • Laurent Peyrin-Biroulet
    • 3
  1. 1.Department of Medicine and GastroenterologyUlster HospitalBelfastUK
  2. 2.South Eastern Health and Social Care TrustBelfastUK
  3. 3.Department of Hepato-Gastroenterology and Inserm U954University Hospital of Nancy, Lorraine UniversityVandoeuvre-lès-NancyFrance

Personalised recommendations