TY - JOUR
T1 - Classifying perianal fistulising Crohn's disease
T2 - an expert consensus to guide decision-making in daily practice and clinical trials
AU - Geldof, Jeroen
AU - Iqbal, Nusrat
AU - LeBlanc, Jean Frédéric
AU - Anandabaskaran, Sulak
AU - Sawyer, Rachel
AU - Buskens, Christianne
AU - Bemelman, Willem
AU - Gecse, Krisztina
AU - Lundby, Lilli
AU - Lightner, Amy L.
AU - Danese, Silvio
AU - Spinelli, Antonino
AU - Carvello, Michele
AU - Faiz, Omar
AU - Warusavitarne, Janindra
AU - Lung, Phillip
AU - De Looze, Danny
AU - D'Hoore, André
AU - Vermeire, Séverine
AU - Hart, Ailsa
AU - Tozer, Phil
N1 - Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/6
Y1 - 2022/6
N2 - Perianal fistulising Crohn's disease is an aggressive disease phenotype that can have a substantial detrimental impact on patients' quality of life. Current biological understanding of perianal fistulising Crohn's disease remains inadequate and previous classification systems have not provided clear guidance on therapy in clinical practice nor on defining patient cohorts within clinical trials. We propose a new classification system for perianal fistulising Crohn's disease that was developed through a modified nominal group technique expert consensus process. The classification identifies four groups of patients. Key elements include stratification according to disease severity as well as disease outcome; synchronisation of patient and clinician goals in decision making, with a proactive, combined medical and surgical approach, on a treat to patient goal basis; and identification of indications for curative fistula treatment, diverting ostomy, and proctectomy. The new classification retains an element of flexibility, in which patients can cycle through different classes over time. Furthermore, with each specific class comes a paired treatment strategy suggestion and description of clinical trial suitability. The proposed classification system is the first of its kind and is an important step towards tailored standardisation of clinical practice and research in patients with perianal fistulising Crohn's disease.
AB - Perianal fistulising Crohn's disease is an aggressive disease phenotype that can have a substantial detrimental impact on patients' quality of life. Current biological understanding of perianal fistulising Crohn's disease remains inadequate and previous classification systems have not provided clear guidance on therapy in clinical practice nor on defining patient cohorts within clinical trials. We propose a new classification system for perianal fistulising Crohn's disease that was developed through a modified nominal group technique expert consensus process. The classification identifies four groups of patients. Key elements include stratification according to disease severity as well as disease outcome; synchronisation of patient and clinician goals in decision making, with a proactive, combined medical and surgical approach, on a treat to patient goal basis; and identification of indications for curative fistula treatment, diverting ostomy, and proctectomy. The new classification retains an element of flexibility, in which patients can cycle through different classes over time. Furthermore, with each specific class comes a paired treatment strategy suggestion and description of clinical trial suitability. The proposed classification system is the first of its kind and is an important step towards tailored standardisation of clinical practice and research in patients with perianal fistulising Crohn's disease.
UR - https://www.scopus.com/pages/publications/85129971174
U2 - 10.1016/S2468-1253(22)00007-3
DO - 10.1016/S2468-1253(22)00007-3
M3 - Journal article
C2 - 35325623
AN - SCOPUS:85129971174
SN - 2468-1253
VL - 7
SP - 576
EP - 584
JO - The Lancet Gastroenterology and Hepatology
JF - The Lancet Gastroenterology and Hepatology
IS - 6
ER -