Evidence map›Paper›PMID 29920726›Full record

SynthesisAlimentary pharmacology & therapeutics2018

An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn's disease.

F Rieder, D Bettenworth, C Ma, C E Parker, L A Williamson, S A Nelson, G van Assche, A Di Sabatino, Y Bouhnik, R W Stidham and 11 more

Open access · bronzeAbstract readSystematic ReviewConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Alimentary pharmacology & therapeutics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 140 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
140citing papers in PubMed, 8 pooled it
13.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

140 citing papers in PubMed, 8 syntheses or guidelines pooled it, 249 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Biomarkers for the Prediction and Diagnosis of Fibrostenosing Crohn's Disease: A Systematic Review.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2022
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Trial
  10. Article
  11. Article
  12. Article
  13. Standardization of international diverticular disease definitions.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026
    Article
  14. Article
  15. Article
  16. Endoscopic stricture management in inflammatory bowel disease: Present and future.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
    Review
  17. Observational
  18. Article
  19. Article
  20. Review

80 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 5 institutions in 3 countries.

F RiederCleveland, OH, USA.ORCID 0000-0002-9087-1568
D BettenworthMünster, Germany.
C MaCalgary, AB, Canada.
C E ParkerLondon, ON, Canada.
L A WilliamsonLondon, ON, Canada.
S A NelsonLondon, ON, Canada.
G van AsscheLeuven, Belgium.
A Di SabatinoPavia, Italy.ORCID 0000-0002-0302-8645
Y BouhnikClichy, France.
R W StidhamAnn Arbor, MI, USA.ORCID 0000-0001-9638-2186
A DignassFrankfurt, Germany.ORCID 0000-0002-9724-054X
G RoglerZürich, Switzerland.
S A TaylorLondon, UK.
J StokerAmsterdam, The Netherlands.
J RimolaBarcelona, Catalonia, Spain.
M E BakerCleveland, OH, USA.
J G FletcherRochester, MN, USA.
J PanesBarcelona, Catalonia, Spain.
W J SandbornLondon, ON, Canada.ORCID 0000-0002-3314-7960
B G FeaganLondon, ON, Canada.ORCID 0000-0002-6914-3822
V JairathLondon, ON, Canada.
Alberta Bible College · CAAmsterdam University of Applied Sciences · NLAnn Arbor Center for Independent Living · USLa Jolla Alcohol Research · USUniversity of Minnesota Rochester · US

Funding

The Cleveland Digestive Diseases Research Core Center (DDRCC)P30DK097948 · NIDDK · CASE WESTERN RESERVE UNIVERSITY · PI Florian Rieder · 2015 to 2026
$15.6M
Combined Training Program in Digestive Disease SciencesT32DK083251 · NIDDK · CLEVELAND CLINIC LERNER COM-CWRU · PI COMINELLI, FABIO, FIOCCHI, CLAUDIO · 2010 to 2025
$3.6M
Microbiota in Intestinal FibrosisK08DK110415 · NIDDK · CLEVELAND CLINIC LERNER COM-CWRU · PI RIEDER, FLORIAN · 2016 to 2020
$767k
NIDDK NIH HHS K08 DK110415NIDDK NIH HHS P30 DK097948NIDDK NIH HHS T32 DK083251
6 · The paper itself

Abstract

backgroundFibrotic stricture is a common complication of Crohn's disease (CD) affecting approximately half of all patients. No specific anti-fibrotic therapies are available; however, several therapies are currently under evaluation. Drug development for the indication of stricturing CD is hampered by a lack of standardised definitions, diagnostic modalities, clinical trial eligibility criteria, endpoints and treatment targets in stricturing CD.

aimTo standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Chron's disease.

methodsAn interdisciplinary expert panel consisting of 15 gastroenterologists and radiologists was assembled. Using modified RAND/University of California Los Angeles appropriateness methodology, 109 candidate items derived from systematic review and expert opinion focusing on small intestinal strictures were anonymously rated as inappropriate, uncertain or appropriate. Survey results were discussed as a group before a second and third round of voting.

resultsFibrotic strictures are defined by the combination of luminal narrowing, wall thickening and pre-stenotic dilation. Definitions of anastomotic (at site of prior intestinal resection with anastomosis) and naïve small bowel strictures were similar; however, there was uncertainty regarding wall thickness in anastomotic strictures. Magnetic resonance imaging is considered the optimal technique to define fibrotic strictures and assess response to therapy. Symptomatic strictures are defined by abdominal distension, cramping, dietary restrictions, nausea, vomiting, abdominal pain and post-prandial abdominal pain. Need for intervention (endoscopic balloon dilation or surgery) within 24-48 weeks is considered the appropriate endpoint in pharmacological trials.

conclusionsConsensus criteria for diagnosis and response to therapy in stricturing Crohn's disease should inform both clinical practice and trial design.

Indexed as

ConsensusCatheterizationClinical Trials as TopicColonConstriction, PathologicCrohn DiseaseDilatationEndoscopyFibrosisHumansIntestinal ObstructionIntestine, SmallPractice Guidelines as TopicReference Standards

Identifiers

PMID29920726
PMCPMC6043370
OpenAlexW2809196018

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.