Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

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

Vader J.-P.a · Froehlich F.b, d · Juillerat P.b · Burnand B.a · Felley C.b · Gonvers J.-J.b · Mottet C.b · Pittet V.a · Dubois R.W.c · Wietlisbach V.a, † · Michetti P.b

Author affiliations

aInstitute of Social and Preventive Medicine, and bDivision of Gastroenterology, University of Lausanne, Lausanne, Switzerland; cCerner Health Insights, Beverly Hills, Calif., USA; and dDivision of Gastroenterology, University of Basle, Basle, Switzerland

Related Articles for ""

Digestion 2006;73:237–248

Do you have an account?

Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: March 30, 2006
Accepted: June 30, 2006
Published online: September 25, 2006
Issue release date: September 2006

Number of Print Pages: 12
Number of Figures: 2
Number of Tables: 8

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

Abstract

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.

© 2006 S. Karger AG, Basel


References

  1. Naylor CD: What is appropriate care? N Engl J Med 1998;338:1918–1920.
  2. Michetti P, Juillerat P, Mottet C, Gonvers JJ, Burnand B, Froehlich F, Vader JP, Felley C: Therapy of mild to moderate luminal disease. Digestion 2005;71:13–18.
  3. Michetti P, Mottet C, Juillerat P, Felley C, Vader JP, Burnand B, Gonvers JJ, Froehlich F: Severe and steroid-resistant Crohn’s disease. Digestion 2005;71:19–25.
  4. Felley C, Mottet C, Juillerat P, Froehlich F, Burnand B, Vader JP, Michetti P, Gonvers JJ: Fistulizing Crohn’s disease. Digestion 2005;71:26–28.
  5. Froehlich F, Juillerat P, Mottet C, Felley C, Vader JP, Burnand B, Gonvers JJ, Michetti P: Obstructive fibrostenotic Crohn’s disease. Digestion 2005;71:29–30.
  6. Gonvers JJ, Juillerat P, Mottet C, Felley C, Burnand B, Vader JP, Michetti P, Froehlich F: Maintenance of remission in Crohn’s disease. Digestion 2005;71:41–48.
  7. Froehlich F, Juillerat P, Felley C, Mottet C, Vader JP, Burnand B, Michetti P, Gonvers JJ: Treatment of post-operative Crohn’s disease. Digestion 2005;71:49–53.
  8. Mottet C, Juillerat P, Gonvers JJ, Michetti P, Burnand B, Vader JP, Felley C, Froehlich F: Treatment of gastroduodenal Crohn’s disease. Digestion 2005;71:37–40.
  9. Juillerat P, Mottet C, Froehlich F, Felley C, Vader JP, Burnand B, Gonvers JJ, Michetti P: Extraintestinal manifestations of Crohn’s disease. Digestion 2005;71:31–36.
  10. Mottet C, Juillerat P, Gonvers JJ, Froehlich F, Burnand B, Vader JP, Michetti P, Felley C: Pregnancy and Crohn’s disease. Digestion 2005;71:54–61.
  11. Juillerat P, Felley C, Mottet C, Froehlich F, Vader JP, Burnand B, Gonvers JJ, Michetti P: Drug safety in Crohn’s disease. Digestion 2005;71:8–12.
  12. Vader JP, Burnand B, Froehlich F, DuBois RW, Bochud M, Gonvers JJ: The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): project and methods. Endoscopy 1999;31:572–578.
  13. Vader JP, Froehlich F, DuBois RW, Beglinger C, Wietlisbach V, Pittet V, Ebel N, Gonvers JJ, Burnand B: The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE): conclusions and www site. Endoscopy 1999;31:687–694.
  14. Brook RH, Chassin MR, Fink A, Salomon DH, Kosecoff J, Park RE: A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 1986;2:53–63.
  15. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, McDonnell J, Vader JP, Kahan JP: The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, RAND, MR-1269/RE/DGXII, 2001.
  16. Sandborn WJ, Feagan BG: Mild to moderate Crohn’s disease – defining the basis for a new treatment algorithm. Aliment Pharmacol Ther 2003;18:263–277.
  17. Lichtensttein GR, Cohen RD, Feagan BG, Sandborn WJ, Salzberg BA, Chen DM, Diamond RH: Safety of infliximab in Crohn’s disease: data from the 5,000-Patient TREAT Registry (abstract). Gastroenterology 2004;126:A54.
  18. Steinhart AH, Hemphill D, Greenberg GR: Sulfasalazine and mesalazine for the maintenance therapy of Crohn’s disease: a meta-analysis. Am J Gastroenterol 1994;89:2116–2124.
  19. Camma C, Giunta M, Rosselli M, Cottone M: Mesalazine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology 1997;113:1465–1473.
  20. Burnand B, Vader JP, Froehlich F, Dupriez K, Larequi-Lauber T, Pache I, Dubois RW, Brook RH, Gonvers JJ: Reliability of panel based guidelines for colonoscopy: an international comparison. Gastrointest Endosc 1998;47:162–166.
  21. Vader JP, Burnand B, Froehlich F, Dupriez K, Larequi-Lauber T, Pache I, Dubois RW, Gonvers JJ, Brook RH: Appropriateness of upper gastrointestinal endoscopy: comparison of American and Swiss criteria. Int J Qual Health Care 1997; 9: 87–92.
  22. Carter MJ, Lobo AJ, Travis SP: IBD Section, British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut 2004;53(suppl 5):V1–V16.
    External Resources
  23. Travis SPL, Stange EF, Lémann M, Öresland T, Chowers Y, Forbes A, D’Haens G, Kitis G, Cortot A, Prantera C, Marteau P, Colombel JF, Gionchetti P, Bouhnik Y, Tiret E, Kroesen J, Starlinger M, Mortensen NJ, for the European Crohn’s and Colitis Organisation (ECCO): European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. Gut 2006;55(suppl 1):i16–i35.
  24. Baiocco PJ, Korelitz BI: The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol 1984;6:211–216.
  25. Kahan JP: ‘Healthcare assessment studies: a rethink. Eurohealth 1996;2:15–17.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: March 30, 2006
Accepted: June 30, 2006
Published online: September 25, 2006
Issue release date: September 2006

Number of Print Pages: 12
Number of Figures: 2
Number of Tables: 8

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.