The Management of Crohn's Disease in Adults and Young People
The Management of Crohn's Disease in Adults and Young People
Background The guideline offers best practice advice on the care of adults, children and young people with Crohn's disease.
Aim To provide clinically effective and cost-effective evidence-based recommendations to guide clinical practice in a clinical guideline commissioned by the National Institute for Health and Clinical Excellence (NICE).
Methods A systematic review of the evidence including critical appraisal, meta-analysis and cost-effectiveness modelling.
Results Thirty-one evidence-based recommendations covering induction and maintenance therapy are available. Five key priorities for implementation are identified together with nine future research recommendations. Three guideline versions are available: short (containing just the recommendations), full (containing the full evidence base) and an Understanding NICE guidance for patients and carers. Algorithms have been produced together with a NICE pathway and implementation tools.
Conclusion These are the first evidence-based clinical and cost-effectiveness guidelines for Crohn's disease in the United Kingdom.
Crohn's disease is a chronic inflammatory disease that mainly affects the gastrointestinal tract. The prevalence of Crohn's disease in the north of England was 145/100 000 and Scotland 157/100 000, meaning there are at least 115 000 people in the UK with Crohn's disease at the present time. Up to one-third of people with Crohn's disease are diagnosed before the age of 21, but there is a lack of studies on treatment for children and young people. The Guideline Development Group was particularly sensitive to issues surrounding growth and physical development as well as psychological and emotional development and educational needs. Several studies have shown a high incidence of psychological morbidity in children and young people as well as adults with Crohn's disease. Crohn's disease can affect the entire gastrointestinal tract, including the mouth and perianal region. The terminal ileum and colon are the most commonly affected sites. Crohn's disease runs a long-term course that includes periods of clinical remission as well as intercurrent exacerbations. People with Crohn's disease may present with symptoms that include abdominal pain, diarrhoea, weight loss and the course of the disease can be associated with considerable debility.
The approach to management therefore needs to combine appropriate deployment of medical, surgical and/or endoscopic treatment with timely information and support. The aims include improving or completely resolving symptoms, improving or restoring quality of life, avoiding hospitalisation and promoting endoscopic mucosal healing whilst minimising adverse events – particularly from drugs such as systemic glucocorticosteroids.
The National Clinical Guideline Centre (NCGC) was commissioned by the National Institute for Health and Clinical Excellence (NICE), based upon a remit received from the Department of Health, to produce a guideline for the management of Crohn's disease. A multidisciplinary Guideline Development Group (GDG) comprising professional members and consumer representatives of the main stakeholders developed the guideline. The guideline was based upon a scope, which underwent consultation with stakeholders. The aim of this article is to provide a summary of the recently published evidence-based guideline, highlighting important recommendations and key changes for clinical practice.
Abstract and Introduction
Abstract
Background The guideline offers best practice advice on the care of adults, children and young people with Crohn's disease.
Aim To provide clinically effective and cost-effective evidence-based recommendations to guide clinical practice in a clinical guideline commissioned by the National Institute for Health and Clinical Excellence (NICE).
Methods A systematic review of the evidence including critical appraisal, meta-analysis and cost-effectiveness modelling.
Results Thirty-one evidence-based recommendations covering induction and maintenance therapy are available. Five key priorities for implementation are identified together with nine future research recommendations. Three guideline versions are available: short (containing just the recommendations), full (containing the full evidence base) and an Understanding NICE guidance for patients and carers. Algorithms have been produced together with a NICE pathway and implementation tools.
Conclusion These are the first evidence-based clinical and cost-effectiveness guidelines for Crohn's disease in the United Kingdom.
Introduction
Crohn's disease is a chronic inflammatory disease that mainly affects the gastrointestinal tract. The prevalence of Crohn's disease in the north of England was 145/100 000 and Scotland 157/100 000, meaning there are at least 115 000 people in the UK with Crohn's disease at the present time. Up to one-third of people with Crohn's disease are diagnosed before the age of 21, but there is a lack of studies on treatment for children and young people. The Guideline Development Group was particularly sensitive to issues surrounding growth and physical development as well as psychological and emotional development and educational needs. Several studies have shown a high incidence of psychological morbidity in children and young people as well as adults with Crohn's disease. Crohn's disease can affect the entire gastrointestinal tract, including the mouth and perianal region. The terminal ileum and colon are the most commonly affected sites. Crohn's disease runs a long-term course that includes periods of clinical remission as well as intercurrent exacerbations. People with Crohn's disease may present with symptoms that include abdominal pain, diarrhoea, weight loss and the course of the disease can be associated with considerable debility.
The approach to management therefore needs to combine appropriate deployment of medical, surgical and/or endoscopic treatment with timely information and support. The aims include improving or completely resolving symptoms, improving or restoring quality of life, avoiding hospitalisation and promoting endoscopic mucosal healing whilst minimising adverse events – particularly from drugs such as systemic glucocorticosteroids.
The National Clinical Guideline Centre (NCGC) was commissioned by the National Institute for Health and Clinical Excellence (NICE), based upon a remit received from the Department of Health, to produce a guideline for the management of Crohn's disease. A multidisciplinary Guideline Development Group (GDG) comprising professional members and consumer representatives of the main stakeholders developed the guideline. The guideline was based upon a scope, which underwent consultation with stakeholders. The aim of this article is to provide a summary of the recently published evidence-based guideline, highlighting important recommendations and key changes for clinical practice.
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