TREATMENT GOALS FOR CROHN'S DISEASE AND ULCERATIVE COLITIS HAVE CHANGED

Treatment for Crohn's disease has changed in recent years, and not just in the medicines that are now being used. Treatment has always been about making the patient better. The difference is really about what "better" means. In the past, it was about making patients "feel better,"–reaching the point where they no longer had pain, diarrhea or blood. And if they couldn't reach that state of "clinical remission," the goal was to have them improve, because the thinking was that if they were feeling and acting better, their disease was under control. 

But that isn't always the case. Patients without symptoms, those who feel well, can still have active intestinal disease with damage occurring, and surgery is still likely for the majority. And they could still be on steroids which was doing its own damage to the body though it might be having some benefit for the intestines. They are feeling well, but their disease is still doing damage.

That's why the treatment goals have changed. Yes, we want to make the patients feel better. And we want them to be able to return to having a normal life (So we even measure their "quality of life"). In children and teens, a normal life also includes normal growth and development (emotional as well as physical). We also want to do that without having them on long-term steroids.

 But to do that we've set the target higher. We want to "heal" the bowel (another name for the intestines). That's a lofty goal, because it means that we are trying to rid the intestine of the ulcers that are the hallmark of Crohn's disease, and we want to prevent fistulas and strictures from forming. In ulcerative colitis, we want to have the intestine look normal on colonoscopy. Why? Because evidence shows that if we can heal the inner surface of the intestine (the mucosa), patients have less chance of requiring hospitalization or surgery. And then they are indeed better, and their disease is under control.