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

doi:10.1038/s41575-024-00935-y

. 2024 Aug;21(8):572-584.

doi: 10.1038/s41575-024-00935-y. Epub 2024 Jun 3.

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

Dominik Bettenworth^{1

2}, Mark E Baker³, Joel G Fletcher⁴, Vipul Jairath^{5

6

7}, Cathy Lu⁸, Willem Bemelman⁹, Geert d'Haens¹⁰, Andre d'Hoore¹¹, Axel Dignass¹², Iris Dotan^{13

14}, Roger Feakins¹⁵, Phillip Fleshner¹⁶, Christina Ha¹⁷, Gaylyn Henderson¹⁸, Ruishen Lyu¹⁹, Julian Panes²⁰, Gerhard Rogler²¹, Ren Mao²², Jordi Rimola²³, William J Sandborn²⁴, Siew C Ng²⁵, Britta Siegmund²⁶, Mark Silverberg²⁷, Stuart A Taylor²⁸, Bram Verstockt^{29

30}, Ilyssa O Gordon³¹, David H Bruining³², Brian G Feagan^{5

6

7}, Florian Rieder^{33

34

35}; Stenosis Therapy Anti-Fibrotic Research (STAR) Consortium

Affiliations

¹ CED Schwerpunktpraxis, Münster, Germany. ced@innere-medizin.de.
² Medical Faculty, University of Münster, Münster, Germany. ced@innere-medizin.de.
³ Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
⁵ Alimentiv Inc, London, Ontario, Canada.
⁶ Department of Medicine, Western University, London, Ontario, Canada.
⁷ Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁹ Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹⁰ Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹¹ Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
¹² Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt am Main, Germany.
¹³ Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel.
¹⁴ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
¹⁵ Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK.
¹⁶ Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁷ Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
¹⁸ Gutless and Glamorous, Atlanta, GA, USA.
¹⁹ Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
²⁰ Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
²¹ Department of Gastroenterology and Hepatology, University Hospital, Zurich, University of Zurich, Zurich, Switzerland.
²² Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²³ Inflammatory bowel disease unit, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, IDIBAPS, Barcelona, Spain.
²⁴ Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, CA, USA.
²⁵ Division of Gastroenterology and Hepatology, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China.
²⁶ Division of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²⁷ Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada.
²⁸ Centre for Medical Imaging, University College London, London, UK.
²⁹ Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
³⁰ Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
³¹ Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³² Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
³³ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³⁴ Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³⁵ Center for Global Translational Inflammatory Bowel Disease Research, Cleveland Clinic, Cleveland, OH, USA.

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

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

Dominik Bettenworth et al. Nat Rev Gastroenterol Hepatol. 2024 Aug.

. 2024 Aug;21(8):572-584.

doi: 10.1038/s41575-024-00935-y. Epub 2024 Jun 3.

Authors

Affiliations

¹ CED Schwerpunktpraxis, Münster, Germany. ced@innere-medizin.de.
² Medical Faculty, University of Münster, Münster, Germany. ced@innere-medizin.de.
³ Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
⁵ Alimentiv Inc, London, Ontario, Canada.
⁶ Department of Medicine, Western University, London, Ontario, Canada.
⁷ Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁹ Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹⁰ Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹¹ Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
¹² Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt am Main, Germany.
¹³ Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel.
¹⁴ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
¹⁵ Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK.
¹⁶ Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁷ Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
¹⁸ Gutless and Glamorous, Atlanta, GA, USA.
¹⁹ Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
²⁰ Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
²¹ Department of Gastroenterology and Hepatology, University Hospital, Zurich, University of Zurich, Zurich, Switzerland.
²² Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²³ Inflammatory bowel disease unit, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, IDIBAPS, Barcelona, Spain.
²⁴ Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, CA, USA.
²⁵ Division of Gastroenterology and Hepatology, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China.
²⁶ Division of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²⁷ Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada.
²⁸ Centre for Medical Imaging, University College London, London, UK.
²⁹ Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
³⁰ Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
³¹ Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³² Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
³³ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³⁴ Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³⁵ Center for Global Translational Inflammatory Bowel Disease Research, Cleveland Clinic, Cleveland, OH, USA.

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

Abstract

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.

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References

1. Torres, J., Mehandru, S., Colombel, J. F. & Peyrin-Biroulet, L. Crohn’s disease. Lancet 389, 1741–1755 (2017). - PubMed - DOI
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 - DOI
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1. Lu, C. et al. Systematic review: medical therapy for fibrostenosing Crohn’s disease. Aliment. Pharmacol. Ther. 51, 1233–1246 (2020). - PubMed - PMC - DOI

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

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

[3] 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 - DOI

[4] 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 - DOI

[5] 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 - DOI

[6] 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 - DOI

[7] 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 - DOI

[8] 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 - DOI

[9] Lu, C. et al. Systematic review: medical therapy for fibrostenosing Crohn’s disease. Aliment. Pharmacol. Ther. 51, 1233–1246 (2020). - PubMed - PMC - DOI

[10] Lu, C. et al. Systematic review: medical therapy for fibrostenosing Crohn’s disease. Aliment. Pharmacol. Ther. 51, 1233–1246 (2020). - PubMed - PMC - DOI

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

Affiliations

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

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