Biologics recommendations in the ECCO guidelines on therapeutics in Crohn's disease: medical treatment

2021 ◽  
pp. flgastro-2021-101881
Author(s):  
Danujan Sriranganathan ◽  
Jonathan P Segal ◽  
Mayur Garg
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Medical Management ◽  
Perianal Disease ◽  
Maintenance Of Remission

In 2019, the European Crohn’s and Colitis Organisation released guidelines for the medical management of Crohn’s disease, concerning the induction of remission, the maintenance of remission and the treatment of fistulising perianal disease. This review summarises the key recommendations regarding the use of biologics in these settings.

scholarly journals Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease

2018 ◽  
Vol 2 (3) ◽  
pp. e35-e63 ◽  
Author(s):  
David R Mack ◽  
Eric I Benchimol ◽  
Jeff Critch ◽  
Jennifer deBruyn ◽  
Frances Tse ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Maintenance Therapy ◽  
Medical Treatment ◽  
Induction Therapy ◽  
Medical Management ◽  
Treatment Success ◽  
Canadian Association ◽  
Moderate Disease

AbstractBackground & AimsWe aim to provide guidance for medical treatment of luminal Crohn’s disease in children.MethodsWe performed a systematic search of publication databases to identify studies of medical management of pediatric Crohn’s disease. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. We developed statements through an iterative online platform and then finalized and voted on them.ResultsThe consensus includes 25 statements focused on medical treatment options. Consensus was not reached, and no recommendations were made, for 14 additional statements, largely due to lack of evidence. The group suggested corticosteroid therapies (including budesonide for mild to moderate disease). The group suggested exclusive enteral nutrition for induction therapy and biologic tumor necrosis factor antagonists for induction and maintenance therapy at diagnosis or at early stages of severe disease, and for patients failed by steroid and immunosuppressant induction therapies. The group recommended against the use of oral 5-aminosalicylate for induction or maintenance therapy in patients with moderate disease, and recommended against thiopurines for induction therapy, corticosteroids for maintenance therapy, and cannabis in any role. The group was unable to clearly define the role of concomitant immunosuppressants during initiation therapy with a biologic agent, although thiopurine combinations are not recommended for male patients. No consensus was reached on the role of aminosalicylates in treatment of patients with mild disease, antibiotics or vedolizumab for induction or maintenance therapy, or methotrexate for induction therapy. Patients in clinical remission who are receiving immunomodulators should be assessed for mucosal healing within 1 year of treatment initiation.ConclusionsEvidence-based medical treatment of Crohn’s disease in children is recommended, with thorough ongoing assessments to define treatment success.

scholarly journals P171 Does microscopic involvement of the surgical margins after ileocececal resection in Crohn’s disease patients predicts early recurrence?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S223-S223
Author(s):  
M ZEMEL ◽  
E Solo ◽  
J Klausner ◽  
H Tulchinsky
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Disease Recurrence ◽  
Male Gender ◽  
Stapled Anastomosis ◽  
Perianal Disease ◽  
Ileocecal Resection ◽  
Resected Specimen ◽  
Histopathological Evidence

Abstract Background Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence. Methods We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins. Results 202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar. We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance. Conclusion The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.

Is reduction from adalimumab 80mg to 40mg sufficient for maintenance of remission in patients with Crohn's disease?

2007 ◽  
Vol 45 (08) ◽  
Author(s):  
M Jürgens ◽  
J Seiderer ◽  
S Brand ◽  
S Pfennig ◽  
B Göke ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Maintenance Of Remission

scholarly journals Vedolizumab for induction and maintenance of remission in Crohn’s disease

2020 ◽  
Author(s):  
Samuel Hui ◽  
Anuj Krishna ◽  
Nik Sheng Ding ◽  
Ray K Boyapati
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Maintenance Of Remission

scholarly journals Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Faruk Karateke ◽  
Ebru Menekşe ◽  
Koray Das ◽  
Sefa Ozyazici ◽  
Pelin Demirtürk
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Gastrointestinal Tract ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Immunosuppressive Therapy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Surgical Options ◽  
Crohn’S Diseases

Crohn's disease may affect any segment of the gastrointestinal tract; however, isolated duodenal involvement is rather rare. It still remains a complex clinical entity with a controversial management of the disease. Initially, patients with duodenal Crohn' s disease (DCD) are managed with a combination of antiacid and immunosuppressive therapy. However, medical treatment fails in the majority of DCD patients, and surgical intervention is required in case of complicated disease. Options for surgical management of complicated DCD include bypass, resection, or stricturoplasty procedures. In this paper, we reported a 33-year-old male patient, who was diagnosed with isolated duodenal Crohn’s diseases, and reviewed the surgical options in the literature.

When should medical treatment of Crohn’s disease stop?

2001 ◽  
Vol 3 ◽  
pp. 11-14
Author(s):  
L. Hultén
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment

Perianal Crohn's Disease in Children and Adolescents

2020 ◽  
Vol 30 (05) ◽  
pp. 395-400
Author(s):  
Annika Mutanen ◽  
Mikko P. Pakarinen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Children And Adolescents ◽  
Perianal Disease ◽  
Ileocecal Region ◽  
Perianal Crohn’S Disease ◽  
Perianal Sepsis ◽  
Endoscopic Assessment ◽  
Perianal Crohn's Disease

AbstractThe incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease localization in the ileocecal region and colon, often associated with perianal disease. Severe complications of perianal disease include recurrent perianal sepsis, chronic fistulae, fecal incontinence, and rectal strictures that impair quality of life and may require fecal diversion. Care of patients with perianal Crohn's disease requires a multidisciplinary approach with systematic clinical evaluation, endoscopic assessment, and imaging studies followed by combined medical and surgical management. In this review, we provide an update of the epidemiology, pathophysiology, diagnostics, and management of perianal Crohn's disease in children and adolescents.

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