Treatment optimisation in inflammatory bowel disease

PART I: TREATMENT OPTIMISATION USING SURGERY
Traditionally surgery is reserved as a last-resort treatment option in case disease complications occur or when other therapies fail. The LIR!C trial is the only randomised controlled trial investigating early use of surgery in CD. Taken together, we believe the initial efficacy analysis of the LIR!C trial, the economic evaluation (chapter 2) and the long-term follow up results (chapter 3) further corroborate that a laparoscopic ileocaecal resection is a valid alternative to infliximab in CD patients with limited inflammatory ileocaecal CD.
PART II: TREATMENT OPTIMISATION USING BIOMARKERS
We provide an overview of clinical trial designs that enable biomarker discovery (chapter 4) and predictive biomarkers of therapy response (chapter 5). To standardize biopsy procurement in CD, in chapter 6 we evaluate the optimal biopsy location to assess histologic disease activity. In the search for protein biomarkers, the diseased intestinal tissue seems most promising being the primary location of disease. However, its use is hampered by need for endoscopy. In chapter 7, we assess the correlation of the inflammatory proteomic profile between the tissue and blood. Poor correlation between both compartments was observed, emphasizing that the blood might not accurately represent pathological processes in the gut. Chapter 8 & 9 focus on the clinically available biomarker ‘faecal calprotectin’ (FCP). We show that an elevated FCP should be interpreted with caution in CD patients with an active perianal fistula and that FCP is an accurate marker for histologic disease activity in UC.