Pharmacological optimization in inflammatory bowel disease

Inflammatory bowel disease (IBD) affects an increasing part of the population and the current prevalence in western countries is aproximately one percent. The main groups Crohns disease (CD) and Ulcerative colitis (UC) differ in anatomical extent and histopathologic caracteristics. A genetic component is apparent and a numerous genes (hur många är man uppe i Jan??) are known to increase the susceptability to develop IBD. The hereditary pattern is stronger for CD but appears to be joint for IBD in general. There is a great heterogenicity in the affected individuals fenotype as well as genotype. With an increasing number of drugs, the need for individualized treatment grows. More availible drugs increases the possiblity to find an effective treatment but it may also expose patient to a larger number of sideffects if the road to finding an appropriate treatment is longer. The potent immunomodulating and immunosupressants used for treatment all have considerable side effects that need to be minimized. The use of genetic testing to predict severe side effects is already in clinical use in treatment with Thiopurines. To increase quality of life and decrease morbidity, we need to shorten the way the right treatment both in terms of safety and efficacy. By studying disease fenotype and genotype in terms of response to treatment, drug use may be optimized. New promising drugs on the market include JAK inhibition which remains to find its place IBD therapy. Real world analysis is necessary in future desicions for appropriate clinical desicions.

The overall aim of this thesis work is to generate new knowledge about how to improve monitoring, evaluating and treating inflammatory conditions of the gut.