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World J Gastroenterol. Aug 7, 2012; 18(29): 3790-3799
Published online Aug 7, 2012. doi: 10.3748/wjg.v18.i29.3790
Crucial steps in the natural history of inflammatory bowel disease
Giovanni Latella, Claudio Papi
Giovanni Latella, Gastroenterology Unit, Department of Internal Medicine and Public Health, University of L’Aquila, 67100 L’Aquila, Italy
Claudio Papi, Gastroenterology and Hepatology Unit, S. Filippo Neri Hospital, 00135 Rome, Italy
Author contributions: Latella G and Papi C wrote the paper.
Correspondence to: Giovanni Latella, MD, Gastroenterology Unit, Department of Internal Medicine and Public Health, University of L’Aquila, Piazza S. Tommasi, 1, Coppito, 67100 L’Aquila, Italy.
Telephone: +39-862-434735 Fax: +39-862-433425
Received: February 6, 2012
Revised: April 18, 2012
Accepted: May 5, 2012
Published online: August 7, 2012

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic, progressive and disabling disorders. Over the last few decades, new therapeutic approaches have been introduced which have led not only to a reduction in the mortality rate but also offered the possibility of a favorable modification in the natural history of IBD. The identification of clinical, genetic and serological prognostic factors has permitted a better stratification of the disease, thus allowing the opportunity to indicate the most appropriate therapy. Early treatment with immunosuppressive drugs and biologics has offered the opportunity to change, at least in the short term, the course of the disease by reducing, in a subset of patients with IBD, hospitalization and the need for surgery. In this review, the crucial steps in the natural history of both UC and CD will be discussed, as well as the factors that may change their clinical course. The methodological requirements for high quality studies on the course and prognosis of IBD, the true impact of environmental and dietary factors on the clinical course of IBD, the clinical, serological and genetic predictors of the IBD course (in particular, which of these are relevant and appropriate for use in clinical practice), the impact of the various forms of medical treatment on the IBD complication rate, the role of surgery for IBD in the biologic era, the true magnitude of risk of colorectal cancer associated with IBD, as well as the mortality rate related to IBD will be stressed; all topics that are extensively discussed in separate reviews included in this issue of World Journal of Gastroenterology.

Keywords: Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Natural history, Clinical course, Complications, Therapy, Surgery, Mortality