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In the past decade, paradigms for inflammatory bowel disease (IBD) management have evolved dramatically. In a review paper, these new paradigms were summarized:
“Treat to target” is now an accepted paradigm. For ulcerative colitis (UC), the target is resolution of rectal bleeding and diarrhea and endoscopic remission (Mayo endoscopic subscore, 0 or 1).
For Crohn disease, treat to target means resolution of abdominal pain and diarrhea and resolution of ulceration at ileocolonoscopy. The authors state that for both UC and Crohn, treat to target could overtreat patients with low progression risk, so a personalized approach is required.
Aggressive early intervention (perhaps within 18 months of diagnosis) is associated with better outcomes, partic…