Evolving treatment algorithms in crohn’s disease

Crohn’s disease (CD) is a chronic, disabling and destructive condition. Half of the patients will develop some bowel damage (stricture, fistula and/or abscess). Current therapeutic strategies failed to alter its natural history. Treatment of CD has evolved 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. 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. This article explores the evolving concepts in assessing disease severity, selecting rigorous treatment end-targets, initiating an effective therapeutic therapy, and managing secondary loss of response.