Biological Therapies in Inflammatory Bowel Disease: Top-down or Bottom-up?

Bas Oldenburg; Daan Hommes


Curr Opin Gastroenterol. 2007;23(4):395-399. 

In This Article


The great advances in medical therapy in IBD have encouraged researchers and physicians to define new and ambitious goals in the treatment of this chronic intermittent disease. The top-down approach is appealing and may result in a modification of the natural history in a subgroup of IBD patients. To date, however, data on the benefits, risks and costs of a reversal of the traditional therapeutic pyramid are limited. In the future, long-term studies aimed at the comparison of the traditional sequential approach and top-down strategies, preferably in homogeneous groups of IBD patients, should guide the clinician in deciding in whom, when and how to introduce early aggressive treatment in daily practice.


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