Exploring life before IBD

Van Schaik et al 1 present new data on serological markers as predictors of inflammatory bowel diseases (IBD) which open new perspectives on thwarting these diseases at their earliest phase. The goals of treatment are currently evolving in IBD (ie, Crohn's disease (CD) and ulcerative colitis (UC)) from mere control of symptoms towards prevention of bowel damage and disability. Despite recent evidence for the efficacy of azathioprine and antitumour necrosis factor therapy to decrease the need for surgery, about a third of CD patients still require intestinal resection at 5 years.2 ,3 As in other chronic diseases such as multiple sclerosis and rheumatoid arthritis there is thus an increasing interest in conducting therapeutic trials early in the course of IBD when there is a window of opportunity to modify the natural history of the disease. An international consensus definition of early CD has recently been proposed which includes disease duration of less than 18 months and no previous use of disease-modifying agents.4 This may not be enough and, pushing the paradigm further, the earliest phase at which we may intervene in the …