An expert consensus to standardise definitions, diagnosis and treatment targets for anti‐fibrotic stricture therapies in Crohn's disease

Abstract

Consensus criteria for diagnosis and response to therapy in stricturing Crohn's disease should inform both clinical practice and trial design.

Editorial: treating strictures in inflammatory bowel disease—authors’ reply

“…A major obstacle in this field is the lack of definitions and appropriate clinical trial endpoints for testing drugs in stricturing CD. This fuelled the development of a global initiative: the CrOhN'S disease anti‐fibrotic STRICTure Therapies (CONSTRICT) study group's expert RAND/UCLA panel . We agree with the comment by Prof. Kamm that the proposed definitions of luminal narrowing, pre‐stenotic dilation and wall thickening will mainly capture patients with severe strictures.…”

“…We thank Professor Kamm for his interest in our paper . We agree that limited attention that has been given to developing therapies to prevent or treat stricturing Crohn's disease (CD).…”

“…However, a validated patient‐reported outcome (PRO) instrument specific for stricturing CD is not available. MRE was considered the preferred imaging modality due to high specificity and sensitivity and lack of radiation exposure . This assessment does not discount the role of abdominal ultrasound in the scenario of routine clinical care, but rather weights the appropriateness of imaging modalities for clinical trial endpoints.…”

Editorial: treating strictures in inflammatory bowel disease

“…In the article by Rieder et al, expert gastroenterologists and radiologists have undertaken a systematic review and consensus voting to establish a stricture definition, define optimal diagnostic tools, and establish clinical trial parameters for drug studies. They considered magnetic resonance imaging (MRI), the optimal modality for stricture definition and monitoring the response to treatment.…”

“…In the study by Bouhnik et al, the primary endpoint comprised obstructive symptom relief with the avoidance of corticosteroids, balloon dilation, and surgery at week 24 of treatment . Rieder et al defined the need for intervention (endoscopic balloon dilation or surgery) within 24‐48 weeks as the most appropriate primary endpoint for drug studies . A primary endpoint that includes symptom relief may be more sensitive to change with therapy.…”