Isaacs, Kim L.

Crohn's disease (CD) is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of CD has steadily increased over the past several decades. The diagnosis and treatment of patients with CD has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with CD. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health care providers should incorporate this guideline along with patient's needs, desires, and their values to care for patients fully and appropriately with CD. Shared decision-making with the patient is advocated. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments later.

Abstract When the only biologics were antitumor necrosis factor agents, it was not hard to treat our sick Crohn's patients. Now with multiple mechanisms of action, the therapeutic landscape is more broad but can be confusing. Trying to compare agents is difficult because head-to-head trials are lacking. A comparative effectiveness methodology allows for indirect comparisons of agents based on the outcome of interest. When deciding what agent is “best” for any specific patient, multiple factors have to be taken into consideration including the primary outcome of interest. In this study, the outcome of mucosal healing is considered.