A global consensus on the definitions, diagnosis and management of fibrostenosing small bowel Crohn's disease in clinical practice.

Journal

Nature reviews. Gastroenterology & hepatology

ISSN: 1759-5053

Titre abrégé: Nat Rev Gastroenterol Hepatol

Pays: England

ID NLM: 101500079

Informations de publication

Date de publication:
03 Jun 2024

Historique:

accepted: 19 04 2024

medline: 4 6 2024

pubmed: 4 6 2024

entrez: 3 6 2024

Statut: aheadofprint

Résumé

Fibrostenosis of the small bowel is common in patients with Crohn's disease. No consensus recommendations on definition, diagnosis and management in clinical practice are currently available. In this Consensus Statement, we present a clinical practice RAND/UCLA appropriateness study on the definition, diagnosis and clinical management of fibrostenosing Crohn's disease. It was conducted by a panel of 28 global experts and one patient representative. Following a systematic literature review, 526 candidate items grouped into 136 questions were generated and subsequently evaluated for appropriateness. Strictures are best defined as wall thickening, luminal narrowing and prestenotic dilation. Cross-sectional imaging is required for accurate diagnosis of fibrostenosing Crohn's disease, and it is recommended before making treatment decisions. It should also assess the degree of inflammation in the bowel wall. Multiple options for medical anti-inflammatory, endoscopic and surgical therapies were suggested, including follow-up strategies following therapy. This Consensus Statement supports clinical practice through providing guidance on definitions, diagnosis and therapeutic management of patients with fibrostenosing small bowel Crohn's disease.

Identifiants

DOI: 10.1038/s41575-024-00935-y PMID: 38831007

pubmed: 38831007

doi: 10.1038/s41575-024-00935-y

pii: 10.1038/s41575-024-00935-y

doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

Torres, J., Mehandru, S., Colombel, J. F. & Peyrin-Biroulet, L. Crohn’s disease. Lancet 389, 1741–1755 (2017).

pubmed: 27914655 doi: 10.1016/S0140-6736(16)31711-1

Rieder, F., Mukherjee, P. K., Massey, W. J., Wang, Y. & Fiocchi, C. Fibrosis in IBD: from pathogenesis to therapeutic targets. Gut 73, 854–866 (2024).

pubmed: 38233198

Farmer, R. G., Whelan, G. & Fazio, V. W. Long-term follow-up of patients with Crohn’s disease. Relationship between the clinical pattern and prognosis. Gastroenterology 88, 1818–1825 (1985).

pubmed: 3922845 doi: 10.1016/0016-5085(85)90006-X

Bettenworth, D. et al. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut 68, 1115–1126 (2019). This systematic review provides a comprehensive summary of currently used radiological approaches for detection and characterization of fibrostenosing Crohn’s disease.

pubmed: 30944110 doi: 10.1136/gutjnl-2018-318081

Lu, C. et al. Systematic review: medical therapy for fibrostenosing Crohn’s disease. Aliment. Pharmacol. Ther. 51, 1233–1246 (2020).

pubmed: 32406116 pmcid: 7777136 doi: 10.1111/apt.15750

Rieder, F. et al. European Crohn’s and Colitis Organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn’s disease. J. Crohns Colitis 10, 873–885 (2016).

pubmed: 26928961 doi: 10.1093/ecco-jcc/jjw055

Bettenworth, D. et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn’s disease. Inflamm. Bowel Dis. 23, 133–142 (2017). Provides a multivariate analysis on efficacy and safety of endoscopic balloon dilation for fibrostenosing complications based on a large database with individual-level data from 676 patients with Crohn’s disease.

pubmed: 28002130 doi: 10.1097/MIB.0000000000000988

Bettenworth, D., Lopez, R., Hindryckx, P., Levesque, B. G. & Rieder, F. Heterogeneity in endoscopic treatment of Crohn’s disease-associated strictures: an international inflammatory bowel disease specialist survey. J. Gastroenterol. 51, 939–948 (2016).

pubmed: 26831355 doi: 10.1007/s00535-016-1172-6

Henderson, N. C., Rieder, F. & Wynn, T. A. Fibrosis: from mechanisms to medicines. Nature 587, 555–566 (2020).

pubmed: 33239795 pmcid: 8034822 doi: 10.1038/s41586-020-2938-9

Bettenworth, D. & Rieder, F. Medical therapy of stricturing Crohn’s disease: what the gut can learn from other organs – a systematic review. Fibrogenes. Tissue Repair. 7, 5 (2014).

doi: 10.1186/1755-1536-7-5

Lin, S. N. et al. Development of antifibrotic therapy for stricturing Crohn’s disease: lessons from randomized trials in other fibrotic diseases. Physiol. Rev. 102, 605–652 (2022).

pubmed: 34569264 doi: 10.1152/physrev.00005.2021

Steiner, C. A. et al. Biomarkers for the prediction and diagnosis of fibrostenosing Crohn’s disease: a systematic review. Clin. Gastroenterol. Hepatol. 20, 817–846.e10 (2022).

pubmed: 34089850 doi: 10.1016/j.cgh.2021.05.054

Gordon, I. O. et al. Histopathology scoring systems of stenosis associated with small bowel Crohn’s disease: a systematic review. Gastroenterology 158, 137–150.e1 (2020).

pubmed: 31476299 doi: 10.1053/j.gastro.2019.08.033

Ma, C. et al. An international consensus to standardize integration of histopathology in ulcerative colitis clinical trials. Gastroenterology 160, 2291–2302 (2021).

pubmed: 33610533 doi: 10.1053/j.gastro.2021.02.035

Gordon, I. O. et al. International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease. Gut 71, 479–486 (2022). Consensus statement on the appropriateness of histopathology scoring systems for fibrostenosing Crohn’s disease.

pubmed: 33952604 doi: 10.1136/gutjnl-2021-324374

Bettenworth, D. et al. Systematic review with meta-analysis: efficacy of balloon-assisted enteroscopy for dilation of small bowel Crohn’s disease strictures. Aliment. Pharmacol. Ther. 52, 1104–1116 (2020).

pubmed: 32813282 pmcid: 8052861 doi: 10.1111/apt.16049

Rieder, F. et al. An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn’s disease. Aliment. Pharmacol. Ther. 48, 347–357 (2018).

pubmed: 29920726 pmcid: 6043370 doi: 10.1111/apt.14853

Bettenworth, D. B. et al. A global consensus on the definitions, diagnosis and management of fibrostenosing small bowel Crohn’s disease. J. Crohns Colitis 17, i418–i420 (2023).

doi: 10.1093/ecco-jcc/jjac190.0400

Wani, S. et al. Development of quality indicators for endoscopic eradication therapies in Barrett’s esophagus: the TREAT-BE (Treatment With Resection and Endoscopic Ablation Techniques for Barrett’s Esophagus) consortium. Am. J. Gastroenterol. 112, 1032–1048 (2017).

pubmed: 28570552 doi: 10.1038/ajg.2017.166

Hansen, R. et al. Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: a RAND appropriateness panel. Gut 70, 1044–1052 (2021).

pubmed: 32873696 doi: 10.1136/gutjnl-2020-322449

Teoh, A. Y. B. et al. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 67, 1209–1228 (2018).

pubmed: 29463614 doi: 10.1136/gutjnl-2017-314341

Bruining, D. H. et al. Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn’s disease. Gastroenterology 154, 1172–1194 (2018).

pubmed: 29329905 doi: 10.1053/j.gastro.2017.11.274

Fitch, K. et al. The RAND/UCLA Appropriateness Method User’s Manual (RAND, 2001).

Rieder, F., Fiocchi, C. & Rogler, G. Mechanisms, management, and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology 152, 340–350.e6 (2017).

pubmed: 27720839 doi: 10.1053/j.gastro.2016.09.047

Hansel, S. L. et al. Clinical benefit of capsule endoscopy in Crohn’s disease: impact on patient management and prevalence of proximal small bowel involvement. Inflamm. Bowel Dis. 24, 1582–1588 (2018).

pubmed: 29788055 doi: 10.1093/ibd/izy050

Panes, J. et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment. Pharmacol. Ther. 34, 125–145 (2011).

pubmed: 21615440 doi: 10.1111/j.1365-2036.2011.04710.x

Chiorean, M. V. et al. Correlation of CT enteroclysis with surgical pathology in Crohn’s disease. Am. J. Gastroenterol. 102, 2541–2550 (2007).

pubmed: 17900329 doi: 10.1111/j.1572-0241.2007.01537.x

Maconi, G. et al. Small bowel stenosis in Crohn’s disease: clinical, biochemical and ultrasonographic evaluation of histological features. Aliment. Pharmacol. Ther. 18, 749–756 (2003).

pubmed: 14510749 doi: 10.1046/j.1365-2036.2003.01673.x

Punwani, S. et al. Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252, 712–720 (2009).

pubmed: 19635832 doi: 10.1148/radiol.2523082167

Colombel, J. F. et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N. Engl. J. Med. 362, 1383–1395 (2010).

pubmed: 20393175 doi: 10.1056/NEJMoa0904492

Kono, T. et al. Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn’s disease: an international multicenter study. J. Gastrointest. Surg. 20, 783–790 (2016).

pubmed: 26696531 doi: 10.1007/s11605-015-3061-3

Lee, S. S. et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 251, 751–761 (2009).

pubmed: 19276325 doi: 10.1148/radiol.2513081184

Ordas, I. et al. Development and validation of a simplified magnetic resonance index of activity for Crohn’s disease. Gastroenterology 157, 432–439.e1 (2019).

pubmed: 30953614 doi: 10.1053/j.gastro.2019.03.051

Maehata, Y. et al. Risk of surgery in patients with stricturing type of Crohn’s disease at the initial diagnosis: a single center experience. Intest. Res. 17, 357–364 (2019).

pubmed: 30781932 pmcid: 6667375 doi: 10.5217/ir.2018.00107

Li, X. H. et al. Characterization of degree of intestinal fibrosis in patients with Crohn disease by using magnetization transfer MR imaging. Radiology 287, 494–503 (2018).

pubmed: 29357272 doi: 10.1148/radiol.2017171221

Wagner, M. et al. Magnetic resonance imaging predicts histopathological composition of ileal Crohn’s disease. J. Crohns Colitis 12, 718–729 (2018).

pubmed: 29300851 pmcid: 7189968 doi: 10.1093/ecco-jcc/jjx186

Serra, C. et al. Real-time elastography for the detection of fibrotic and inflammatory tissue in patients with stricturing Crohn’s disease. J. Ultrasound 20, 273–284 (2017).

pubmed: 29204231 pmcid: 5698189 doi: 10.1007/s40477-017-0265-2

Zappa, M. et al. Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathologic analysis. Inflamm. Bowel Dis. 17, 984–993 (2011).

pubmed: 20722053 doi: 10.1002/ibd.21414

Adler, J. et al. Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm. Bowel Dis. 18, 849–856 (2012).

pubmed: 21710535 doi: 10.1002/ibd.21801

Bouhnik, Y. et al. Efficacy of adalimumab in patients with Crohn’s disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut 67, 53–60 (2018). Multicentre, prospective, observational cohort study in patients with Crohn’s disease with symptomatic small-bowel strictures demonstrating therapeutic efficacy of adalimumab.

pubmed: 28119352 doi: 10.1136/gutjnl-2016-312581

Schulberg, J. D. et al. Intensive drug therapy versus standard drug therapy for symptomatic intestinal Crohn’s disease strictures (STRIDENT): an open-label, single-centre, randomised controlled trial. Lancet Gastroenterol. Hepatol. 7, 318–331 (2022). Open-label, RCT demonstrating that Crohn’s disease strictures are responsive to drug treatment and that treat-to-target therapy intensification resulted in numerically fewer treatment failures and a reduction in stricture-associated inflammation.

pubmed: 34890567 doi: 10.1016/S2468-1253(21)00393-9

Battat, R. et al. Association between ustekinumab trough concentrations and clinical, biomarker, and endoscopic outcomes in patients with Crohn’s disease. Clin. Gastroenterol. Hepatol. 15, 1427–1434.e2 (2017).

pubmed: 28365485 doi: 10.1016/j.cgh.2017.03.032

Roblin, X. et al. Addition of azathioprine to the switch of anti-TNF in patients with IBD in clinical relapse with undetectable anti-TNF trough levels and antidrug antibodies: a prospective randomised trial. Gut 69, 1206–1212 (2020).

pubmed: 31980448 doi: 10.1136/gutjnl-2019-319758

Rubin de Celix, C., Chaparro, M. & Gisbert, J. P. Real-world evidence of the effectiveness and safety of ustekinumab for the treatment of Crohn’s disease: systematic review and meta-analysis of observational studies. J. Clin. Med. 11, 4202 (2022).

pubmed: 35887966 pmcid: 9317084 doi: 10.3390/jcm11144202

Shen, B. et al. Practical guidelines on endoscopic treatment for Crohn’s disease strictures: a consensus statement from the Global Interventional Inflammatory Bowel Disease Group. Lancet Gastroenterol. Hepatol. 5, 393–405 (2020).

pubmed: 31954438 doi: 10.1016/S2468-1253(19)30366-8

Ding, N. S. et al. Endoscopic dilatation of Crohn’s anastomotic strictures is effective in the long term, and escalation of medical therapy improves outcomes in the biologic era. J. Crohns Colitis 10, 1172–1178 (2016).

pubmed: 26971054 doi: 10.1093/ecco-jcc/jjw072

Ponsioen, C. Y. et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol. Hepatol. 2, 785–792 (2017).

pubmed: 28838644 doi: 10.1016/S2468-1253(17)30248-0