- Fecal Incontinence
|Difficult-to-treat inflammatory bowel disease: results from an international consensus meeting
Lancet Gastroenterol Hepatol. 2023 Sep;8(9):853-859.doi: 10.1016/S2468-1253(23)00154-1. Epub 2023 Jul 6.
Tommaso Lorenzo Parigi 1, Ferdinando D'Amico 2, Maria T Abreu 3, Axel Dignass 4, Iris Dotan 5, Fernando Magro 6, Anne M Griffiths 7, Vipul Jairath 8, Marietta Iacucci 9, Gerassimos J Mantzaris 10, Colm O'Morain 11, Walter Reinisch 12, David B Sachar 13, Dan Turner 14, Takayuki Yamamoto 15, David T Rubin 16, Laurent Peyrin-Biroulet 17, Subrata Ghosh 18, Silvio Danese 19
1Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
2Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
3Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
4Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt, Germany.
5Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
6Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.
7Division of Gastroenterology, SickKids Hospital, University of Toronto, Toronto, ON, Canada.
8Departments of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada.
9Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland.
10Department of Gastroenterology, GHA Evangelismos-Polykliniki, Athens, Greece.
11Department of Gastroenterology, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland.
12Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
13The Dr Henry J Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
14Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
15IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan.
16University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.
17University of Lorraine, Inserm, NGERE, F-54000, Nancy, France.
18APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland.
19Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: email@example.com.
Many patients with inflammatory bowel disease (IBD) have persistent symptoms and disease activity despite the best available medical or surgical treatments. These patients are commonly referred to as having difficult-to-treat IBD and need additional therapeutic strategies. However, the absence of standard definitions has impeded clinical research efforts and comparisons of data. Under the guidance of the endpoints cluster of the International Organization for the Study of Inflammatory Bowel Disease, we held a consensus meeting to propose a common operative definition for difficult-to-treat IBD. 16 participants from 12 countries voted on 20 statements covering various elements of difficult-to-treat IBD, such as failure of medical and surgical treatments, disease phenotypes, and specific complaints from patients. "Agreement" was defined as at least 75% consensus. The group agreed that difficult-to-treat IBD is defined by the failure of biologics and advanced small molecules with at least two different mechanisms of action, or postoperative recurrence of Crohn's disease after two surgical resections in adults, or one in children. In addition, chronic antibiotic-refractory pouchitis, complex perianal disease, and comorbid psychosocial complications that impair disease management also qualified as difficult-to-treat IBD. Adoption of these criteria could serve to standardise reporting, guide enrolment in clinical trials, and help identify candidates for enhanced treatment strategies.