Extraintestinal Manifestations of Crohn’s Disease

Juillerat, Pascal; Mottet, Christian; Froehlich, Florian; Felley, Christian; Vader, John‐Paul; Burnand, Bernard; Gonvers, Jean‐Jacques; Michetti, Pierre

doi:10.1159/000083870

Cited by 56 publications

(27 citation statements)

References 129 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The precision of each CD category was therefore evaluated by documenting criteria included in the definitions proposed for broad clinical categories of CD [6,7,8,9,10,11,12]. If the medical record reported at least one of the criteria from the definitions and included supporting documentation, this element was considered as ‘present and precise’.…”

Section: Methodsmentioning

confidence: 99%

Evaluating Appropriateness of Treatment for Crohn’s Disease: Feasibility of an Explicit Approach

et al. 2007

Self Cite

View full text Add to dashboard Cite

Background: Situations where practical therapeutic decisions differ from guidelines in the management of patients with Crohn’s disease (CD) have been described through opinion surveys. The feasibility of actually documenting these situations using an explicit approach has not been examined. Objective: The aim of this study was to evaluate the feasibility of a retrospective application of appropriateness criteria to a population of CD patients. Methods: Medical records of a cohort of patients diagnosed with CD were systematically reviewed. We used appropriateness criteria for treatment of CD that had been developed by the European Panel on the Appropriateness of Crohn’s Disease Therapy (EPACT). First we evaluated the level of precision of the elements abstracted from medical records needed in order to be able to apply these criteria. We then assessed the appropriateness of treatment for different CD categories. Only participants with at least one physician encounter during the preceding 6 months were included. Results: 260 patient medical records were reviewed on site at 22 gastroenterologists’ offices over a 2-month period in 2005. 116 (44%) patients were excluded because they had not had at least one medical visit at their referred gastroenterologist during the preceding 6 months. Medical records for 8 additional patients (3%) were not accessible. 136 (53%) medical records including 148 encounters were available for analysis. Overall, elements necessary to determine the appropriateness of treatment were available in 94% (139/148) of encounters. These elements were available in more than 90% of cases for all CD categories except for mild-moderate luminal active CD where 66% were available. Among those with all necessary elements available, 18% of treatments were judged as appropriate, 29% inappropriate, 38% uncertain according to the EPACT criteria, and for the other 15%, appropriateness had not been rated by the EPACT panel. Conclusions: The information necessary to assess the appropriateness of treatment of major types of CD was generally both present and precise in medical records. Therefore, in addition to the intended prospective use of these criteria, retrospective evaluation of the appropriateness of CD treatment using medical records is also feasible with the EPACT criteria.

show abstract

Section: Methodsmentioning

confidence: 99%

Evaluating Appropriateness of Treatment for Crohn’s Disease: Feasibility of an Explicit Approach

et al. 2007

Self Cite

View full text Add to dashboard Cite

show abstract

“…This review is an updated version of a prior publication published as a preparatory work for the European Panel on the Appropriateness of Crohn ’ s Disease Therapy (EPACT) held in 2004 [3] and entirely replaces the earlier publication.…”

Section: Introductionmentioning

confidence: 99%

Extraintestinal Manifestations of Crohn’s Disease

et al. 2007

Self Cite

View full text Add to dashboard Cite

In each case of extraintestinal manifestations of Crohn’s disease, active disease, if present, should be treated to induce remission, which may positively influence the course of most concomitant extraintestinal manifestations. For some extraintestinal manifestations, however, a specific treatment should be introduced. This latter part of disease management will be discussed in this chapter, in particular for pyoderma gangrenosum, uveitis, spondylarthropathy – axial arthropathy – and primary sclerosing cholangitis, which have also been described in quiescent Crohn’s disease. Few new drugs for the treatment of extraintestinal manifestations of Crohn’s disease have been developed in the past and only the role of infliximab has increased in Crohn’s disease-related extraintestinal manifestations. Drugs specifically aimed at this treatment, stemming from a few randomized controlled studies or case series, are sulfasalazine, 5-ASA, corticosteroids, azathioprine or 6-mercaptopurine, methotrexate, infliximab, adalimumab, etanercept and cyclosporine or tacrolimus. Unfortunately, because of the paucity of data in this field, the best evidence presented and discussed in this article for the treatment of these extraintestinal manifestations is extrapolated from patients that for the most part did not suffer from Crohn’s disease.

show abstract

“…This was subsequently expanded manually to include references contained in review articles and references suggested by the panelists. The selected studies were arranged hierarchically according to evidence-based medicine criteria and commented on in a series of review articles [2,3,4,5,6,7,8,9,10,11]. References to the primary studies are to be found in those articles.…”

Section: Methodsmentioning

confidence: 99%

Appropriate Treatment for Crohn’s Disease: Methodology and Summary Results of a Multidisciplinary International Expert Panel Approach – EPACT

et al. 2006

View full text Add to dashboard Cite

Background/Aims: For many therapeutic decisions in Crohn’s disease (CD), high-grade evidence is lacking. To assist clinical decision-making, explicit panel-based appropriateness criteria were developed by an international, multidisciplinary expert panel. Methods: 10 gastroenterologists, 3 surgeons and 2 general practitioners from 12 European countries assessed the appropriateness of therapy for CD using the RAND Appropriateness Method. Their assessment was based on the study of a recent literature review of the subject, combined with their own expert clinical judgment. Panelists rated clinical indications and treatment options using a 9-point scale (1 = extremely inappropriate; 9 = extremely appropriate). These scenarios were then discussed in detail at the panel meeting and re-rated. Median ratings and disagreement were used to aggregate ratings into three assessment categories: appropriate (A), uncertain (U) and inappropriate (I). Results: 569 specific indications were rated, dealing with 9 clinical presentations: mild/moderate luminal CD (n = 104), severe CD (n = 126), steroid-dependent CD (n = 25), steroid-refractory CD (n = 37), fistulizing CD (n = 49), fibrostenotic CD (n = 35), maintenance of medical remission of CD (n = 84), maintenance of surgical remission (n = 78), drug safety in pregnancy (n = 24) and use of infliximab (n = 7). Overall, 146 indications (26%) were judged appropriate, 129 (23%) uncertain and 294 (52%) inappropriate. Frank disagreement was low (14% overall) with the greatest disagreement (54% of scenarios) being observed for treatment of steroid-refractory disease. Conclusions: Detailed explicit appropriateness criteria for the appropriate use of therapy for CD were developed for the first time by a European expert panel. Disease location, severity and previous treatments were the main factors taken into account. User-friendly access to EPACT criteria is available via an Internet site, www.epact.ch, allowing prospective evaluation and improvement of appropriateness of current CD therapy.

show abstract

Extraintestinal Manifestations of Crohn’s Disease

Cited by 56 publications

References 129 publications

Evaluating Appropriateness of Treatment for Crohn’s Disease: Feasibility of an Explicit Approach

Evaluating Appropriateness of Treatment for Crohn’s Disease: Feasibility of an Explicit Approach

Extraintestinal Manifestations of Crohn’s Disease

Appropriate Treatment for Crohn’s Disease: Methodology and Summary Results of a Multidisciplinary International Expert Panel Approach – EPACT

Contact Info

Product

Resources

About