Digestive experts grade treatment options for inflammatory bowel disease

A section reviewing the epidemiology of IBD highlights several risk factors, including geography, smoking and appendectomy, the importance of the interplay between genes and environmental factors, including diets high in refined sugar, the role of the gut microbiome and the immune system, as well as the so-called "hygiene hypothesis" as a proposed explanation for the increased incidence of IBD in industrialized nations.

The ACG Institute for Clinical Research & Education convened an expert Task Force to undertake a systematic review of trials evaluating medical therapies of active and quiescent CD and UC. Therapeutic approaches to inducing and maintaining remission, as well as preventing relapse, were included in the analysis. The evidence for the following therapies was included in the systematic review: 5-ASAs, corticosteroids, antibiotics, biologics and immunosuppressants.

"A series of systematic reviews performed by methodologists and supported by IBD experts provides an authoritative perspective on the efficacy of medical therapies in IBD," explained Paul Moayyedi, B.Sc., M.B. Ch.B., Ph.D., MPH, FRCP, FRCPC, FACG, who, along with colleagues at McMaster University and University of Leeds conducted the comprehensive meta-analysis. Dr. Moayyedi also serves as Co-Editor of AJG. "The assessment of all the trials in both UC and CD using the same criteria by one group of researchers gives a unique overview of the strength and quality of the evidence."

"While many review articles, including systematic reviews, have been published on therapy for IBD, the ACG Task Force represents the most rigorous attempt to date to synthesize all of the available evidence in an unbiased fashion. I believe it will prove an invaluable guide for clinicians and investigators," commented Nicholas J. Talley, M.D., Ph.D., FACG, who chaired the ACG IBD Task Force.

"ACG's goal was to highlight the wealth of randomized controlled trial data that can guide the clinician in the medical management of IBD," explained Delbert L. Chumley, M.D, FACG, President of the American College of Gastroenterology.