The updated STRIDE-III recommendations refine the international treat-to-target framework for Crohn’s disease and ulcerative colitis, incorporating new evidence on inflammatory outcomes and patient-centered measures. The update draws on a systematic review that included 1,018 studies, alongside surveys of adult and pediatric gastroenterology experts.
The framework distinguishes three categories of treatment targets. Actionable targets include clinical response and remission, C-reactive protein normalization, fecal calprotectin within the target range, and endoscopic remission. Adjunctive targets, such as urgency, histological remission in ulcerative colitis, transmural remission in Crohn’s disease, and growth, help guide treatment optimization and monitoring but do not necessarily require a change in therapeutic class. Patient-centered targets include disability, fatigue, and quality of life, with impairments prompting assessment for inflammation and other contributing factors.
STRIDE-III also defines time-based treatment targets, treatment-specific timelines, updated fecal calprotectin thresholds, and adaptations for resource-limited settings.