The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis

Assche, Gert Van; Dignaß, Axel; Panés, Julián; Beaugerie, Laurent; Karagiannis, John A.; Allez, Matthieu; Ochsenkühn, Thomas; Orchard, Tim; Rogler, Gerhard; Louis, Édouard; Kupčinskas, Limas; Mantzaris, Gerassimos J.; Travis, Simon; Stange, Eduard F.

doi:10.1016/j.crohns.2009.12.003

Cited by 1,111 publications

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“…1,4 Although appropriate use of conventional and biologic therapies can induce mucosal healing, a significant number of patients experience primary or secondary non-response. 1,5 Patients with treatment refractory CD are prepared to undergo a significant treatment related risk to achieve remission. 6 There has been considerable interest in case reports that autologous haematopoietic stem cell transplantation (HSCT) can induce sustained disease remission in such patients.…”

Section: Introductionmentioning

confidence: 99%

Autologous stem-cell transplantation in treatment-refractory Crohn's disease: an analysis of pooled data from the ASTIC trial

Lindsay

Allez

Clark

et al. 2017

The Lancet Gastroenterology & Hepatology

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BACKGROUND The randomised controlled ASTIC trial showed no benefit of mobilisation and autologous haematopoietic stem-cell transplantation (HSCT) compared with mobilisation followed by conventional therapy using a stringent primary endpoint (steroid-free clinical remission for 3 months with no endoscopic or radiological evidence of intestinal inflammation) in patients with treatment-refractory Crohn's disease. We now assess HSCT in patients enrolled in the ASTIC trial using endpoints that are traditional for clinical trials in Crohn's disease, and identify factors that predict benefit or harm. METHODS Patients who underwent mobilisation and were randomly assigned to conventional therapy in the ASTIC trial were offered HSCT at 1 year and underwent complete assessment for a further year. We report analyses of the combined cohort of patients who underwent HSCT at any time during the ASTIC trial programme. The primary outcome for this analysis was 3-month steroid-free clinical remission at 1 year after HSCT (Crohn's Disease Activity Index [CDAI] <150). We also examined the degree of endoscopic healing at 1 year. Multivariate analysis was performed to identify factors associated with achieving the primary endpoint by using logistic regression, and factors associated with experiencing a serious adverse event using Poisson regression. Participants were not masked to treatment, but the adjudication panel that reviewed radiology and endoscopy was masked to allocation and visits. All patients who underwent HSCT and had data available at baseline and 1-year follow-up were included in the primary and safety analysis. This trial is registered with ClinicalTrials.gov, number NCT00297193. FINDINGS Between June 28, 2007, and Sept 1, 2011, 45 patients were enrolled in the ASTIC trial from 11 European transplant units. 23 patients were randomly assigned to immediate HSCT, and 22 patients were assigned to mobilisation followed by conventional care. After completion of the ASTIC trial, 17 patients from the conventional care group received HSCT. In the combined cohort, data were available for 40 patients at baseline and 38 patients at 1 year after HSCT (one patient died, one withdrew). At 1 year after HSCT, 3-month steroid-free clinical remission was seen in 13 (38%, 95% CI 22-55) of 34 patients with available data for the whole year. Complete endoscopic healting was noted in 19 (50%, 34-66) of 38 patients. On multivariate analyses, factors associated with the primary outcome were short disease duration (odds ratio [OR] 0·64, 95% CI 0·41-0·997 per year; p=0·048) and low baseline CDAI (0·82, 0·74-0·98 per 10 units; p=0·031). 76 serious adverse events occurred in 23 of 40 patients with available data. The most common serious adverse event was infection, most of which were treatment related. Smoking and perianal disease at baseline were independent factors associated with the number of serious adverse events (OR 3·07 [95% CI 1·75-5·38; p=0·0001] for smoking and 3·97 [2·17-7·25; p<0·0001] for perianal disease) on multivariate...

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Section: Introductionmentioning

confidence: 99%

Autologous stem-cell transplantation in treatment-refractory Crohn's disease: an analysis of pooled data from the ASTIC trial

Lindsay

Allez

Clark

et al. 2017

The Lancet Gastroenterology & Hepatology

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“…The diagnosis of CD is based on a combination of clinical symptoms, laboratory tests and imaging data, and a single gold standard is lacking [2]. Ileocolonoscopy is the first line of investigation in the diagnosis, management, and monitoring of CD [3]; however, endoscopy is not always complete, and there are several limitations related to the invasiveness, procedure-related discomfort, risk of bowel perforation and relatively poor patient acceptance. Ileocolonoscopy also does not evaluate the extent of ileal disease, transmural damage, and lesions in the perineal region, such as fistulas and abscesses.…”

Section: Introductionmentioning

confidence: 99%

“…The European Crohn's and Colitis Organisation (ECCO) and American College of Gastroenterology guidelines considered CT or MRI as radiological imaging techniques with the highest diagnostic accuracy for the detection of intestinal involvement of CD, including extramural complications [3,8]. In a recent consensus conducted by the ECCO and European Society Gastrointestinal and Abdominal Radiology (ESGAR), no significant differences in diagnostic accuracy among the imaging techniques (US, CT, MRI) were observed [9].…”

Section: Introductionmentioning

confidence: 99%

SICUS and CEUS imaging in Crohn’s disease: an update

et al. 2017

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Endoscopy remains the main technique in the diagnosis and treatment of Crohn's disease (CD); nevertheless, the recent development of innovative and non-invasive imaging techniques has led to a new tool in the exploration of small bowel in CD patients. This paper reviews the available data on ultrasound imaging used for the evaluation of CD, highlighting the role of small intestine contrast-enhanced ultrasonography with the use of oral and intravenous contrast agents.Keywords Crohn's disease Á Contrast-enhanced ultrasound Á Small intestine contrast ultrasonography Sommario Nell'iter diagnostico e terapeutico della malattia di Crohn l'endoscopia rappresenta la principale metodica strumentale. Tuttavia, la recente introduzione di tecniche di imaging innovative e non invasive ha implementato lo studio dell'intestino nelle malattie infiammatorie croniche intestinali. La seguente revisione raccoglie i dati disponibili in letteratura relativi all'utilizzo dell'ecografia con mezzo di contrasto, sia orale (SICUS) sia endovenoso (CEUS), nella valutazione dei pazienti affetti da malattia di Crohn.

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“…ECCO report that extent of disease of more than 100 cm is considered as a risk factor for recurrence [25]. In the present study, none of the studied factors related to the disease is considered as a risk of surgical recurrence.…”

Section: Duration Of Diseasementioning

confidence: 58%

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

Makni¹

2017

Austin J Gastroenterol

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Objective: The surgery is required in more than 80% of patients with Crohn's disease. Crohn's disease is associated with high rates of postoperative recurrence. The aim of the study was to identify, the risk factors of postoperative 'surgical recurrence' after the first resection for Crohn's disease. Methodology:We report a retrospective study from January 1998 to September 2010 that studied 226 patients originated only from Tunisia (in North Africa), operated on for MC. We had been interested to the risk factor of surgical recurrence of Crohn's disease.Results: Mean age was 33 years. The average time between the onset of the disease and the surgical procedure was 31 months. The diagnosis of CD was established preoperatively in 213 patients (94%). The diagnosis was made intraoperatively because of an acute complication in 5 cases (2.2%) and postoperatively in 8 cases (3.5%). The most common location was the ileocecal junction in 184 cases (81.4%). The most common type of lesion was the mixed form (stricture and fistula) in 123 cases (54.4%). Operative mortality was 0.04% (n=1). Specific morbidity was 8.4% (n=19). In long term, a surgical recurrence was noted in 18 patients (8%). In multivariate analysis, independent risk factors for recurrence were: smoking (p=0.012, ORs=3.57) and post-operative medical treatment (p=0.05, ORs=2.6). Conclusion:Our series is unique for a lower rate of the postoperative recurrence (8%). The two risk factors of recurrence are smoking and the necessity of postoperative medical prophylaxis.

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The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis

Cited by 1,111 publications

References 159 publications

Autologous stem-cell transplantation in treatment-refractory Crohn's disease: an analysis of pooled data from the ASTIC trial

Autologous stem-cell transplantation in treatment-refractory Crohn's disease: an analysis of pooled data from the ASTIC trial

SICUS and CEUS imaging in Crohn’s disease: an update

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

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