Clinical profiles of moderate and severe Crohn's disease patients and use of anti-tumor necrosis factor agents: Greek expert consensus guidelines

Abstract

Crohn's disease (CD) is a chronic idiopathic infl ammatory bowel disease (IBD) which affects any site of the gastrointestinal tract and occasionally extraintestinal organs. The natural history of CD varies remarkably but a considerable proportion of patients develop complications leading to hospitalizations and surgeries, impaired quality of life, and disability. In these patients, effective medical therapy should aim beyond control of clinical symptoms to include induction and maintenance of steroid-free clinical and serological remission and mucosal healing, as this has shown to reduce complications, hospitalizations and surgeries, and to decrease the risk of colorectal cancer, at least in the short term. This therapeutic goal can be achieved in a considerable proportion of patients with anti-tumor necrosis factor (TNF)-α agents if applied early in the disease course. Clinical recommendations from a panel of Greek IBD experts are herein provided, regarding the clinical profi les and the use of anti-TNF-α therapy in patients with moderate and severe CD, based on literature review and personal experience. The objectives of this advisory workshop were to defi ne the profi les of patients with moderate and severe CD using routine clinical and laboratory parameters, as well as the clinical profiles of patients with moderate CD, severe CD, perianal CD, and/or extraintestinal manifestations, who are candidates for biologic therapies. Emphasis was given on patients with newly diagnosed CD. Th e proposed recommendations may provide a useful and practical approach for improving therapeutic strategies with anti-TNF-α in patients with active moderate and severe CD.

Keywords Crohn's disease, infl ammatory bowel disease, anti-tumor necrosis factor-α agents, extra-intestinal manifestations, expert consensus guidelines

Ann Gastroenterol 2015; 28 (4): 417-425