Management of Crohn's Disease in Adults

Abstract

Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

“…The magnitude of the preference for a conventional step-up approach is nonetheless striking -especially considering the liberal reimbursement situation in Switzerland -and may appear somewhat "outdated". However, using an immunosuppressant agent first with or without a corticosteroid is completely in line with major CDtreatment recommendations and guidelines 15,19,35 . This practice is not in contradiction to the increasing body of evidence, that anti-TNF based strategies are more effective in achieving crucial CD endpoints 18 and the recently published data on thiopurines, revealing no benefit of an early introduction regarding the primary endpoints 16,36 .…”

“…The most preferred TNF-antagonist is infliximab (IFX, 47.1%) followed by adalimumab (ADA, 10.9%) and certolizumab pegol (CTZ, 0.8%), while 41.2% of all gastroenterologists have no specific preference for a TNF-antagonist. IFX is mainly preferred by gastroenterologists treating ≤ 10 patients per year with anti-TNF (57.6% vs. 35.2% for physicians treating > 10 patients per year; p=0.02). To address LOR most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the TNF-inhibitor and adding a thiopurine.…”

Colorectal Adenocarcinoma and Inflammatory Bowel Disease: An Update and Review

“…A meta-analysis of the data revealed inconsistent results though, largely dependent on the referral base of each study [73]. 5-ASA is a treatment that is recommended in some cases of UC, while expert opinion cautions against its use in CD [74,75].…”

Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

“…3 The clinical presentation depends on the part of the affected intestine and varies from mild to severe malnutrition, abdominal pain, diarrhoea, weight loss, fever and rectal bleeding. 5,8 The symptom pattern in children is different from that of adults and is characterised by anaemia, fever, growth failure and/or delayed puberty. 8 …”