Evolution of therapeutic targets in inflammatory bowel disease, from symptom control to comprehensive disease control and disease modification: a scoping review protocol

Inflammatory bowel diseases (IBD)—principally Crohn's disease and ulcerative colitis—are chronic, immune-mediated disorders with heterogeneous, relapsing–remitting trajectories and the potential for progressive, irreversible bowel damage and disability. Therapeutic goals have shifted from symptom control toward objective inflammatory control (treat-to-target; STRIDE and STRIDE-II) and, increasingly, toward long-term disease modification. In parallel, the operational concept of remission has deepened successively—clinical, biochemical, endoscopic, histological, and transmural—generating progressively more sensitive metrics of residual disease. A central conceptual gap motivates this review: a prognostic marker is not automatically a therapeutic target. Whether treating to deeper endpoints (e.g., histological remission in ulcerative colitis, transmural healing in Crohn's disease) yields incremental benefit over established targets remains unresolved. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, and the JBI Evidence Synthesis database did not identify an existing or in-progress scoping review mapping this conceptual evolution across the full range of monitoring domains. A scoping review is the appropriate approach because the objective is to map the breadth and conceptual structure of a heterogeneous, evolving evidence base rather than to answer a single effectiveness question.