Evolving short- and long-term goals of management of IBD: getting it right, making it last.

Short- and long-term treatment targets in inflammatory bowel diseases (IBD) evolved during the last decade, shifting from symptom control to endoscopic healing and patient-centered parameters. STRIDE-II consensus placed these targets on a timeline from initiating treatment, and introduced additional targets, normalization of serum and fecal biomarkers, absence of quality of life and disability as well as restoration of growth in children. Transmural healing in Crohn's disease and histological healing in ulcerative colitis currently serve as adjunct measures to gauge remission depth. However, whether early treatment according to a treat-to-target paradigm impacts the natural course of IBD remains unclear, leading to the need for prospective disease-modification trials. The SPIRIT consensus defines the targets for these trials to assess the long-term impact of early treatment on quality of life, disability, disease complications, risk of neoplastic lesions and mortality. As further data emerge about the risk-benefit balance of aiming toward deeper healing, the targets in treating IBD may continue to shift.