Optimizing conventional medical therapies in inflammatory bowel disease in 2014

Goals of therapy for inflammatory bowel disease have advanced beyond symptom control to the normalization of biomarkers of inflammation, and mucosal healing in particular, with the expectation that this will change the natural history of these diseases. Concurrent with higher treatment expectations has come an expanded therapeutic armamentarium to achieve these goals, and a greater ability to optimize each therapeutic class to maximize therapeutic benefits and minimize unnecessary treatment failures. In addition to these advances has come the evolution of therapeutic drug monitoring which is increasingly being utilized to optimize the use of immunomodulators and biologic therapies in particular. This review will outline the principals of optimization of the conventional medical therapies available to the clinician today.