Monitoring & follow-up
If you have been managing Inflammatory Bowel Disease (IBD) for a while, you may have noticed a shift in how your gastroenterologist talks about treatment goals. Instead of simply asking whether you feel better, they may be ordering lab work and scoping you even when your symptoms are under control. This reflects a strategy called treat to target, and it represents the modern standard of care for both Crohn's disease and ulcerative colitis. The idea is straightforward: rather than treating until you feel okay, your care team sets specific, measurable goals and adjusts your treatment until those goals are met. Understanding what those targets are (and why they matter) can help you participate more effectively in your own care.
Why "Feeling Fine" Is Not the Full Picture
Most IBD patients naturally gauge their disease by how they feel. If the urgency stops, the pain eases, and the bleeding resolves, remission seems obvious. But gastroenterologists have known for years that symptoms tell an incomplete story. In the SONIC trial, only about half of Crohn's disease patients in clinical remission also had endoscopic remission, meaning the other half had ongoing intestinal inflammation despite feeling well. This gap between symptoms and mucosal healing is called subclinical inflammation, and it has real consequences. Undetected inflammation can silently cause strictures, fistulas, and progressive bowel damage that leads to surgery. The treat-to-target approach exists specifically to close this gap by defining remission with objective measurements, not just a patient's subjective experience.
What the STRIDE Guidelines Actually Recommend
The framework behind treat to target IBD comes from the STRIDE-II guidelines, published in 2021 by the International Organization for the Study of IBD (IOIBD). STRIDE stands for Selecting Therapeutic Targets in Inflammatory Bowel Disease, and the second iteration established a layered set of time-bound treatment goals. In the short term (weeks to months), the targets are symptom improvement and normalization of blood and stool biomarkers like C-reactive protein (CRP) and fecal calprotectin. In the long term, the targets expand to include endoscopic healing (confirmed absence of visible inflammation during colonoscopy), restoration of quality of life, and absence of disability. The STRIDE-II update was significant because it formally added quality of life and disability as treatment targets, not just biological measures. This means your GI team is not just chasing lab numbers; they are trying to help you live a full, unrestricted life, confirmed by objective evidence that your disease is truly quiet at the tissue level.
The Monitoring Targets That Matter
So what gets measured in a treat-to-target approach, and how often? The two most common IBD remission monitoring tools between colonoscopies are blood-based CRP and stool-based fecal calprotectin. CRP is a general marker of inflammation in the body, with a short half-life that makes it useful for tracking rapid changes. Fecal calprotectin is more specific to intestinal inflammation and correlates more closely with endoscopic findings than CRP does. The American Gastroenterological Association (AGA) guidelines suggest that for patients in symptomatic remission, a fecal calprotectin below 150 micrograms per gram can help rule out active inflammation without requiring a colonoscopy. A systematic review of asymptomatic IBD patients found that those with repeatedly elevated fecal calprotectin had a 53 to 83 percent probability of relapsing within two to three months, while those with consistently normal results had a 67 to 94 percent chance of staying in remission. In practice, your GI team may check these biomarkers every one to three months during active treatment adjustments, then every six to twelve months once you are stable.
How Tracking Supports a Treat-to-Target Approach
Treat to target works best when your care team has a complete picture of your disease between clinic visits. That picture relies not only on lab results but also on consistent, structured data about your symptoms, medications, and day-to-day patterns. When you track your bowel frequency, pain levels, fatigue, and medication adherence over weeks and months, you create a longitudinal record that helps your gastroenterologist spot trends that a single appointment cannot capture. A rising symptom score alongside a stable calprotectin might suggest a functional overlay rather than active inflammation, while worsening biomarkers in someone who "feels great" might prompt earlier endoscopic evaluation to check for subclinical inflammation IBD that could cause long-term damage. The STRIDE guidelines patient framework depends on this kind of regular assessment. Apps like Aidy help IBD patients track symptoms, labs, and medications to support a treat-to-target approach with their GI teams.
What to Ask Your Doctor
If your gastroenterologist has not explicitly discussed treat-to-target goals with you, the next appointment is a good time to start. Three questions worth asking:
What are my current short-term and long-term treatment targets, and how will we measure progress toward mucosal healing?
How often should I be getting fecal calprotectin or CRP tests to monitor for subclinical inflammation between scopes?
What would need to change in my results or symptoms for you to consider adjusting my treatment plan?
These questions signal to your care team that you understand modern IBD management and are prepared to participate actively. The STRIDE-II framework was designed with regular reassessment in mind, and patients who engage with the process by tracking consistently and asking informed questions help make that framework work in practice.