IBD Science for Patients

When you’re managing Crohn’s disease or ulcerative colitis, working with your gastroenterologist to set clear treatment goals is essential for keeping your bowel health on track. For many years, medical care followed an approach called Treat-to-Target, where doctors adjusted your medications until specific health markers reached healthy levels. However, as new treatments and scanning tools have emerged, doctors faced a growing dilemma: how deep should you push for gut healing before the risk of over-modifying your medication outweighs the benefit?

Now, a major global consensus brings much-needed clarity. Developed by the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) and the Porto group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the new STRIDE-III guidelines establish a clear, three-tiered framework that separates medical targets that require changing your treatment from those that simply guide monitoring.

Behind the Technology: Understanding the Three New Treatment Categories

To understand how STRIDE-III changes your daily care, it helps to look at the clinical terminology and evaluation methods introduced by the international panel:

• Treat-to-Target: A medical strategy where doctors choose specific measurable goals (such as zero bleeding or normal stool tests) and regularly check them. If a target is not met, your doctor optimises your current dose or switches to a medicine with a different mechanism of action.
• Modified Delphi Consensus: A high-tech research method where an international panel of experts completes multiple rounds of anonymous voting and surveys. A statement is only approved if at least 75 per cent of specialists agree, ensuring that final recommendations reflect worldwide scientific consensus.
• The Three STRIDE-III Target Categories:
  1. Actionable Targets: Critical health goals that prove whether a treatment is working. If you do not reach an actionable target after an adequate trial, your care team should generally adjust or switch your medication. These include feeling symptom-free (clinical remission), normalising blood inflammation (C-Reactive Protein or CRP), lowering stool inflammation (faecal calprotectin), and achieving visual gut healing during a camera check (endoscopic remission).
  2. Adjunctive Targets: Desirable secondary goals, such as microscopic tissue healing (histological remission in ulcerative colitis) or deep bowel wall healing seen on scans (transmural healing in Crohn’s disease using intestinal ultrasound or MRI). While these goals predict great long-term health, failing to achieve them on their own does not justify switching your medication if your actionable targets are already satisfied. This prevents unnecessary treatment changes.
  3. Patient-Centred Targets: Priorities defined directly by you, including freedom from sudden bowel urgency, overcoming daily fatigue, and restoring your emotional quality of life.

Inside the Evidence: Scale and Scope of the International Consensus

This project was a large-scale international evidence synthesis and expert consensus initiative. The research team analysed data collected between July 2019 and April 2025 across global databases.

The consensus process involved an extensive scientific workload:

1. Massive Literature Review: Scientists screened 13,071 research records, ultimately integrating evidence from 1,018 clinical studies (462 focused on Crohn’s disease, 335 on ulcerative colitis, and 221 on mixed populations).
2. Global Expert Surveys: Detailed clinical surveys were completed by 60 leading IBD gastroenterologists from the IOIBD and 23 paediatric gastroenterology specialists from the European Porto group.
3. Paediatric and Adult Integration: Unlike older guidelines, STRIDE-III incorporates specific timelines and calprotectin thresholds tailored for children and teenagers as well as adults.

Key Recommendations: Smarter Targets and Realistic Timelines

The STRIDE-III framework introduces several practical changes to modern IBD care:

1. Clear Distinctions to Prevent Overtreatment: The guidelines explicitly warn against switching medications purely to chase microscopic tissue healing if your bowel lining looks visually healthy, your stool tests are normal, and you feel well.
2. Updated Faecal Calprotectin Thresholds: Stool calprotectin tests remain a central actionable marker, but thresholds are refined to recognise that minor fluctuations do not automatically mean your treatment has failed.
3. Prominence for Bowel Urgency and Fatigue: For the first time, reducing bowel urgency is highlighted as both a primary patient-centred goal and a key clinical signal, ensuring doctors address sudden toilet trips alongside lab tests.
4. Intestinal Ultrasound Integration: The guidelines endorse non-invasive intestinal ultrasound (a gentle bedside scan using soundwaves to measure bowel wall thickness) as an effective tool for monitoring transmural healing in Crohn’s disease without requiring frequent colonoscopies.

Why This Matters to You as a Patient

Whether you are managing long-standing IBD or supporting a child with a recent diagnosis, this landmark international guidance offers reassuring, balanced direction for your healthcare journey:

1. This Study Proves That Deeper Remission Does Not Always Mean Changing Pills: This study proves that pushing for microscopic perfection is not always necessary if your main inflammation markers are clear and you feel well. Knowing this protects you from discarding a biological drug that is currently keeping you safe.
2. This Study Provides Evidence That Your Daily Symptoms Take Centre Stage: This study provides evidence that your personal priorities, like overcoming bowel urgency and fatigue, are now formally recognised as core targets in global medical guidelines.
3. This Study Shows That Children Get Tailored Care Plans: This study shows that young people with Crohn’s and colitis benefit from specific paediatric guidelines that support growth and school life while avoiding unnecessary procedures.

By separating essential medical targets from secondary goals, the STRIDE-III framework helps you and your gastroenterologist make confident, balanced decisions that protect both your bowel lining and your everyday quality of life.