Evidence map›Paper›PMID 31799497›Full record

ReviewJournal of the Canadian Association of Gastroenterology2018

Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn's Disease: The Toronto Consensus.

A Hillary Steinhart, Remo Panaccione, Laura Targownik, Brian Bressler, Reena Khanna, John K Marshall, Waqqas Afif, Charles N Bernstein, Alain Bitton, Mark Borgaonkar and 14 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of the Canadian Association of Gastroenterology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Approach to medical therapy in perianal Crohn's disease.World journal of gastroenterology · 2021
    Review
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

A Hillary SteinhartDivision of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Remo PanaccioneDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada.
Laura TargownikSection of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada.
Brian BresslerDepartment of Medicine, Division of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia, Canada.
Reena KhannaDepartment of Medicine, University of Western Ontario, London, Ontario, Canada.
John K MarshallDivision of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Waqqas AfifDepartment of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Charles N BernsteinSection of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada.
Alain BittonDepartment of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Mark BorgaonkarFaculty of Medicine, Memorial University, St John's, Newfoundland, Canada.
Usha ChauhanHamilton Health Sciences, Hamilton, Ontario, Canada.
Brendan HalloranDivision of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Jennifer JonesDepartment of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Erin KennedyDivision of General Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Grigorios I LeontiadisDivision of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Edward V LoftusDivision of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Jonathan MeddingsDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada.
Paul MoayyediDivision of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Sanjay MurthyDivision of Gastroenterology, University of Ottawa, Ottawa, Ontario, Canada.
Sophie PlamondonDepartment of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.
Greg RosenfeldDivision of Gastroenterology, Pacific Gastroenterology Associates, Vancouver, British Columbia, Canada.
David SchwartzInflammatory Bowel Disease Center, Vanderbilt University, Nashville, Tennessee, USA.
Cynthia H SeowDepartments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Chadwick WilliamsDivision of Digestive Care & Endoscopy, Department of Medicine, Dartmouth General Hospital, Halifax, Nova Scotia, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFistulas occur in about 25% of patients with Crohn's disease (CD) and can be difficult to treat. The aim of this consensus was to provide guidance for the management of patients with perianal fistulizing CD.

methodsA systematic literature search identified studies on the management of fistulizing CD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform using a modified Delphi process, then finalized, and voted on by a group of specialists.

resultsThe quality of evidence for treatment of fistulizing CD was generally of very low quality, and because of the scarcity of good randomized controlled trials (RCTs), these consensus statements generally provide conditional suggestions (5 of 7 statements). Imaging and surgical consultations were recommended in the initial assessment of patients with active fistulizing CD, particularly those with complicated disease. Antibiotic therapy is useful for initial symptom control. Antitumor necrosis factor (anti-TNF) therapy was recommended to induce symptomatic response, and continued use was suggested to achieve and maintain complete remission. The use of concomitant immunosuppressant therapies may be useful to optimize pharmacokinetic parameters when initiating anti-TNF therapy. When there has been an inadequate symptomatic response to medical management strategies, surgical therapy may provide effective fistula healing for some patients.

conclusionsOptimal management of perianal fistulizing CD requires a collaborative effort between gastroenterologists and surgeons and may include the evidence-based use of existing therapies, as well as surgical assessments and interventions when needed.

Indexed as

antibioticantitumor necrosis factorendoscopic ultrasoundmagnetic resonance imagingrecommendations

Identifiers

PMID31799497
PMCPMC6542243

What OpenQuestion holds

Textmetadata
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.