Introduction

Crohn’s disease [CD] is a chronic inflammatory bowel disease [IBD] that can result in progressive bowel damage and disability. CD can affect individuals of any age, from children to the elderly,^2,3 and may cause significant morbidity and impact on quality of life [QoL]. The precise aetiology of CD remains unknown and a curative therapy is not yet available. Contemporary therapy therefore is focused on control of inflammation, using medications along with timely surgical interventions to alleviate the symptoms of bowel damage.

Abstract

The current consensus guideline offers a comprehensive and practical guidance on the diagnostic and monitoring of patients with inflammatory bowel disease (IBD). It provides recommendations on requirements for initial diagnosis, detection of complications, the use of monitoring tools in patients with IBD and diagnostics in specific situations, such as pregnancy, postoperatively and for cancer surveillance. The guideline is a joint project of the European Crohn’s and Colitis Organization (ECCO), the European Society of Gastrointestinal and Abdominal Radiology, the European Society of Pathology, and the International Bowel Ultrasonography Group under the leadership of ECCO.

Background

The global incidence of colorectal cancer (CRC) continues to increase, accompanied by improvements in overall and disease-specific survival. Consequently, there are about 5 million survivors of CRC worldwide, with a range of unmet needs affecting physical, psychological, and social functioning. Gastrointestinal dysfunction is a common problem following surgical treatment for CRC, with a reported incidence of up to 50% at 10 years post-operatively. It presents with a constellation of symptoms, including abdominal pain and distension and variable bowel habits (e.g. constipation, diarrhoea, fragmentation), all of which require different management strategies. These long-term sequelae can have a significant impact on patients' overall well-being and quality of life (QoL). Recent studies have shown that a specific cause for gastrointestinal symptoms was found in 80% of patients when examined in a clinic dedicated to late sequelae after colorectal surgery. Additionally, 70% of these patients experienced improvement after treatment. Similar outcomes were observed in a nurse-led clinic, highlighting the clinical and socio-economic value of recognising and addressing of these complications.

Summary

Genetic cholestatic liver diseases are caused by (often rare) mutations in a multitude of different genes. While these diseases differ in pathobiology, clinical presentation and prognosis, they do have several commonalities due to their cholestatic nature. These Clinical Practice Guidelines (CPGs) offer a general approach to genetic testing and management of cholestatic pruritus, while exploring diagnostic and treatment approaches for a subset of genetic cholestatic liver diseases in depth. An expert panel appointed by the European Association for the Study of the Liver has created recommendations regarding diagnosis and treatment, based on the best evidence currently available in the fields of paediatric and adult hepatology, as well as genetics. The management of these diseases generally takes place in a tertiary referral centre, in order to provide up-to-date approaches and expertise. These CPGs are intended to support hepatologists (for paediatric and adult patients), residents and other healthcare professionals involved in the management of these patients with concrete recommendations based on currently available evidence or, if not available, on expert opinion.

Source file

https://doi.org/10.1016/j.jhep.2024.04.006