Evidence map›Paper›PMID 35006492›Full record

ArticleDigestive diseases and sciences2022

Appropriateness of Medical and Surgical Treatments for Chronic Pouchitis Using RAND/UCLA Appropriateness Methodology.

Gaurav Syal, Miles P Sparrow, Fernando Velayos, Adam S Cheifetz, Shane Devlin, Peter M Irving, Gilaad G Kaplan, Laura E Raffals, Thomas Ullman, Krisztina B Gecse and 4 more

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Article in Digestive diseases and sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.4field-weighted citation impact, top 35% 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

0 citing papers in PubMed, 2 citations in OpenAlex.

No citing paper in PubMed yet.

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

14 authors at 11 institutions in 5 countries.

Gaurav SyalInflammatory Bowel Disease Center, Cedars-Sinai Medical Center, 8730 Alden Drive, E225, Los Angeles, CA, 90048, USA. gaurav.syal@cshs.org.ORCID 0000-0002-5803-5877
Miles P SparrowThe BRIDGe Group, The Alfred Hospital, Melbourne, VIC, Australia.
Fernando VelayosThe BRIDGe Group, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Adam S CheifetzThe BRIDGe Group, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Shane DevlinThe BRIDGe Group, University of Calgary, Calgary, AB, Canada.
Peter M IrvingThe BRIDGe Group, Guy's and St. Thomas' Hospitals, London, UK.
Gilaad G KaplanThe BRIDGe Group, University of Calgary, Calgary, AB, Canada.
Laura E RaffalsThe BRIDGe Group, Mayo Clinic, Rochester, MN, USA.
Thomas UllmanAlbert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Krisztina B GecseAmsterdam University Medical Center, Amsterdam, Netherlands.
Phillip R FleshnerCedars Sinai Medical Center, Los Angeles, CA, USA.
Amy L LightnerCleveland Clinic, Cleveland, OH, USA.
Corey A SiegelThe BRIDGe Group, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Gil Y MelmedThe BRIDGe Group, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Cedars-Sinai Medical Center · USUniversity of Calgary · CAAlbert Einstein College of Medicine · USAmsterdam University Medical Centers · NLBeth Israel Deaconess Medical Center · USCleveland Clinic · USDartmouth–Hitchcock Medical Center · USKaiser Permanente San Francisco Medical Center · USMayo Clinic · USSt Thomas' Hospital · GBThe Alfred Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsThe treatment of chronic pouchitis remains a challenge due to the paucity of high-quality studies. We aimed to provide guidance for clinicians on the appropriateness of medical and surgical treatments in chronic pouchitis.

methodsAppropriateness of medical and surgical treatments in patients with chronic pouchitis was considered in 16 scenarios incorporating presence/absence of four variables: pouchitis symptoms, response to antibiotics, significant prepouch ileitis, and Crohn's disease (CD)-like complications (i.e., stricture or fistula). Appropriateness of permanent ileostomy in patients refractory to medical treatments was considered in eight additional scenarios. Using the RAND/UCLA appropriateness method, international IBD expert panelists rated appropriateness of treatments in each scenario on a 1-9 scale.

resultsChronic antibiotic therapy was rated appropriate only in asymptomatic antibiotic-dependent patients with no CD-like complications and inappropriate in all other scenarios. Ileal-release budesonide was rated appropriate in 6/16 scenarios including patients with significant prepouch ileitis but no CD-like complications. Probiotics were considered either inappropriate (14/16) or uncertain (2/16). Biologic therapy was considered appropriate in most scenarios (14/16) and uncertain in situations where significant prepouch ileitis or CD-like complications were absent (2/16). In patients who are refractory to all medications, permanent ileostomy was considered appropriate in all scenarios (7/8) except in asymptomatic patients with no CD-like complications.

conclusionsIn the presence of significant prepouch ileitis or CD-like complications, chronic antibiotics and probiotics are inappropriate. Biologics are appropriate in all patients except in asymptomatic patients with no evidence of complications. Permanent ileostomy is appropriate in most medically refractory patients.

Indexed as

Biological ProductsCrohn DiseaseGraft vs Host DiseaseIleitisPouchitisAnti-Bacterial AgentsBudesonideHumansAnti-Bacterial AgentsBiological ProductsBudesonideBiologicsBudesonideChronic antibioticsChronic pouchitisCrohn’s disease-like complicationsPermanent ileostomyPrepouch ileitisProbioticsRAND appropriateness methodology

Identifiers

PMID35006492
OpenAlexW4206531585

What OpenQuestion holds

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Registered trials

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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.