An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn's disease.
An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn's disease.
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DOI：
10.1111/apt.14853
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发表时间：
2018-08
影响因子：
7.6
通讯作者：
Jairath V
中科院分区：
文献类型：
--
作者：
Rieder F;Bettenworth D;Ma C;Parker CE;Williamson LA;Nelson SA;van Assche G;Di Sabatino A;Bouhnik Y;Stidham RW;Dignass A;Rogler G;Taylor SA;Stoker J;Rimola J;Baker ME;Fletcher JG;Panes J;Sandborn WJ;Feagan BG;Jairath V
纤维化狭窄是克罗恩病（CD）的常见并发症，约占所有患者的一半。目前尚无特异性抗纤维化疗法;然而，目前正在评估几种疗法。狭窄性CD适应症的药物开发因缺乏标准化定义、诊断方式、临床试验合格标准、终点和治疗靶点而受到阻碍。一个由15名胃肠病学家和放射科医生组成的跨学科专家小组被召集起来。使用改良的兰德/加州大学洛杉矶适当性方法，将来自系统综述和专家意见的109个候选项目匿名评定为不适当、不确定或适当）。在第二轮和第三轮投票之前，对调查结果进行了分组讨论。纤维化狭窄由管腔狭窄、管壁增厚和狭窄前扩张的组合定义。吻合口（在既往肠切除吻合部位）和初始小肠狭窄的定义相似，但吻合口狭窄的壁厚存在不确定性。磁共振成像被认为是确定纤维化狭窄和评估治疗反应的最佳技术。症状性狭窄的定义为腹胀、绞痛（即绞痛性腹痛）、饮食限制、恶心、呕吐、腹痛（持续时间和强度）和餐后腹痛（持续时间和强度）。认为24 - 48周内需要干预（内镜球囊扩张或手术）是药理学试验的适当终点。狭窄性克罗恩病的诊断和治疗反应的共识标准应告知临床实践和试验设计。
Fibrotic stricture is a common complication of Crohn’s disease (CD) affecting approximately half of all patients. No specific anti-fibrotic therapies are available; however, several therapies are currently under evaluation. Drug development for the indication of stricturing CD is hampered by a lack of standardized definitions, diagnostic modalities, clinical trial eligibility criteria, endpoints and treatment targets in stricturing CD. An interdisciplinary expert panel consisting of 15 gastroenterologists and radiologists was assembled. Using modified RAND/University of California Los Angeles appropriateness methodology, 109 candidate items derived from systematic review and expert opinion focusing on small intestinal strictures were anonymously rated as inappropriate, uncertain or appropriate). Survey results were discussed as a group before a second and third round of voting. Fibrotic strictures are defined by the combination of luminal narrowing, wall thickening and pre-stenotic dilation. Definitions of anastomotic (at site of prior intestinal resection with anastomosis) and naïve small bowel strictures were similar, however there was uncertainty regarding wall thickness in anastomotic strictures. Magnetic resonance imaging is considered the optimal technique to define fibrotic strictures and assess response to therapy. Symptomatic strictures are defined by abdominal distension, cramping (i.e. colicky abdominal pain), dietary restrictions, nausea, vomiting, abdominal pain (duration and intensity) and postprandial abdominal pain (duration and intensity). Need for intervention (endoscopic balloon dilation or surgery) within 24 to 48 weeks is considered the appropriate endpoint in pharmacological trials. Consensus criteria for diagnosis and response to therapy in stricturing Crohn’s disease should inform both clinical practice and trial design.
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影响因子：
4.9
作者：
Bettenworth, Dominik;Gustavsson, Anders;Rieder, Florian
通讯作者：
Rieder, Florian
影响因子：
24.5
作者：
Bouhnik Y;Carbonnel F;Laharie D;Stefanescu C;Hébuterne X;Abitbol V;Nachury M;Brixi H;Bourreille A;Picon L;Bourrier A;Allez M;Peyrin-Biroulet L;Moreau J;Savoye G;Fumery M;Nancey S;Roblin X;Altwegg R;Bouguen G;Bommelaer G;Danese S;Louis E;Zappa M;Mary JY;GETAID CREOLE Study Group
通讯作者：
GETAID CREOLE Study Group
影响因子：
29.4
作者：
Rieder F;Fiocchi C;Rogler G
通讯作者：
Rogler G
影响因子：
12.6
作者：
Fumery, Mathurin;de Chambrun, Guillaume Pineton;Peyrin-Biroulet, Laurent
通讯作者：
Peyrin-Biroulet, Laurent
影响因子：
2.4
作者：
Orscheln, Emily S.;Dillman, Jonathan R.;Trout, Andrew T.
通讯作者：
Trout, Andrew T.