Year: 2012
Type: article
Abstract: Introduction: Crohn s disease is a chronic inflammatory disease from gastrointestinal tract. The increase in incidence and heterogeneity of this pathology, with different presentations and prognostics leads to a constant concern in developing and improving its classification and treatment. Objectives: To establish recommendations (based on level of evidence and recommendation grades) to 5 questions considered as the clinical challenges of the therapeutic approach in Crohn s disease. Methods: The methodology adopted by the working group DC2 (Desafios Clínicos na Doença de Crohn) was based on the selection of 5 questions, by voting, and establishing recommendations to each question proposed to each subgroup. Discussion and approval of reflexions and final recommendations was carried out in a consensus meeting. Conclusion: It has been possible to base conclusions about the questions under study on evidence, being recommended: 1) having Crohn s disease under 40 years old, structuring phenotype disease and anal disease are predictive factors of bad prognostic; 2) it is possible to consider suspension of biologics in patients with endoscopic remission and normal biomarkers; 3) patients with biochemical markers of disease activity (CRP and calprotectina) have more probability of relapse; 4) in failure of biologics it is essential to assure that treatment with the first drug was optimized: with infliximab it s demonstrated that either reduction of the administration range or increasing the dose allows to recover the response in the majority of patients; as for adalimumab, patients should change from bimonthly to weekly administrations; 5) in case of Crohn s disease with intestinal surgery, use of therapeutic to reduce postoperative recurrence is indicated, particularly immunosupressors and biologics.
Authors: Magro,Fernando, Correia,Luis, Lago,Paula, Macedo,Guilherme, Peixe,Paula, Portela,Francisco, Dias,Jorge Amil, Barros,Luísa, Belo,Teresa, Caldeira,Paulo, Cerqueira,Rute, Chagas,Cristina, Correia,Manuel, Ferreira,Aníbal, Freire,Paulo, Gonçalves,Ana Rita, Gonçalves,Raquel, Herculano,Rita, Lopes,Susana, Santos,Paula Moura, Machado,Artur, Morna,Henrique, Pimentel,Rita, Ramos,Jaime, Reis,Jorge, Rodrigues,Susana, Rosa,Isadora, Salgado,Marta, Vasconcelos,Helena, Vieira,Ana Isabel
Institutions: Hospital de São João, Hospital de Santa Maria, Hospital de Santo António, Hospital de Egas Moniz, Unidade Local de Saúde de Coimbra, University of Coimbra, Centro Hospitalar do Tâmega e Sousa, Hospital de Faro EPE, Hospital de São Sebastião, Hospital de Santa Cruz, Hospital de São Marcos, Hospital Dr. Nélio Mendonça, Hospital Santo António dos Capuchos, Hospital Pulido Valente, Instituto Português de Oncologia Francisco Gentil, Hospital de Santo André, Hospital Garcia de Orta
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2107905367