Treatment of Postoperative Crohn’s Disease

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

doi:10.1159/000083873

Cited by 21 publications

(12 citation statements)

References 73 publications

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“…Up to 80% of all patients suffering from Crohn's disease undergo surgery at least once during the course of their disease, stricture formation being the most common indication in a high proportion of them. Moreover, recurrence of stricture formation is common at the site of surgical anastomosis (25,31,102).…”

Section: Intestinal Fibrosis In Humans: the Clinical Problemmentioning

confidence: 99%

Animal models of intestinal fibrosis: new tools for the understanding of pathogenesis and therapy of human disease

Rieder

Kessler

Sans

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

122

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Fibrosis is a serious condition complicating chronic inflammatory processes affecting the intestinal tract. Advances in this field that rely on human studies have been slow and seriously restricted by practical and logistic reasons. As a consequence, well-characterized animal models of intestinal fibrosis have emerged as logical and essential systems to better define and understand the pathophysiology of fibrosis. In point of fact, animal models allow the execution of mechanistic studies as well as the implementation of clinical trials with novel, pathophysiology-based therapeutic approaches. This review provides an overview of the currently available animal models of intestinal fibrosis, taking into consideration the methods of induction, key characteristics of each model, and underlying mechanisms. Currently available models will be classified into seven categories: spontaneous, gene-targeted, chemical-, immune-, bacteria-, and radiation-induced as well as postoperative fibrosis. Each model will be discussed in regard to its potential to create research opportunities to gain insights into the mechanisms of intestinal fibrosis and stricture formation and assist in the development of effective and specific antifibrotic therapies.

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Section: Intestinal Fibrosis In Humans: the Clinical Problemmentioning

confidence: 99%

Animal models of intestinal fibrosis: new tools for the understanding of pathogenesis and therapy of human disease

Rieder

Kessler

Sans

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

122

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“…The development of explicit criteria of appropriateness of the use of various postoperative treatment regimens will be a useful aid to clinical decision making in this context. 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 [1] and entirely replaces the earlier publication.…”

Section: Introductionmentioning

confidence: 99%

Maintenance of Surgically Induced Remission of Crohn’s Disease

Froehlich¹,

Juillerat²,

Pittet³

et al. 2007

Digestion

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At 1 year after a first resection, up to 80% of patients show an endoscopic recurrence, 10–20% have clinical relapse, and 5% have surgical recurrence. Smoking is one of the most important risk factors for postoperative recurrence. Preoperative disease activity and the severity of endoscopic lesions in the neoterminal ileum within the first postoperative year are predictors of symptomatic recurrence. Mesalazine is generally the first-line treatment used in the postoperative setting but still provokes considerable controversy as to its efficacy, in spite of the results of a meta-analysis. Immunosuppressive treatment (azathioprine, 6-mercaptopurine) is based on scant evidence but is currently used as a second-line treatment in postsurgical patients at high risk for recurrence, with symptoms or with early endoscopic lesions in the neoterminal ileum. Nitroimidazole antibiotics (metronidazole, ornidazole) are also effective in the control of active Crohn’s disease in the postoperative setting. Given their known toxicity, they may be used as a third-line treatment as initial short-term prevention therapy rather than in the long term. Conventional corticosteroids, budesonide or probiotics have no proven role in postoperative prophylaxis. Infliximab has not as yet been studied for use in the prevention of relapse after surgery.

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“…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

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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.

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Treatment of Postoperative Crohn’s Disease

Cited by 21 publications

References 73 publications

Animal models of intestinal fibrosis: new tools for the understanding of pathogenesis and therapy of human disease

Animal models of intestinal fibrosis: new tools for the understanding of pathogenesis and therapy of human disease

Maintenance of Surgically Induced Remission of Crohn’s Disease

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

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