First explicit criteria to decide on the appropriateness of therapy of ulcerative colitis: the European EPATUC panel
Details
Serval ID
serval:BIB_35B69B077195
Type
Inproceedings: an article in a conference proceedings.
Publication sub-type
Abstract (Abstract): shot summary in a article that contain essentials elements presented during a scientific conference, lecture or from a poster.
Collection
Publications
Institution
Title
First explicit criteria to decide on the appropriateness of therapy of ulcerative colitis: the European EPATUC panel
Title of the conference
DDW 2012, Digestive Disease Week
Address
San Diego, California, United-States, May 20-22, 2012
ISBN
0016-5085
ISSN-L
0021-9355
Publication state
Published
Issued date
2012
Volume
142
Series
Gastroenterology
Pages
S224
Language
english
Abstract
Background: Ulcerative colitis (UC) is a chronic disease with a wide variety of treatment
options many of which are not evidence based. Supplementing available guidelines, which
are often broadly defined, consensus-based and generally not tailored to specifically reflect
the individual patient situation, we developed explicit appropriateness criteria to assist, and
improve treatment decisions. Methods: We used the RAND appropriateness method which
does not force consensus. An extensive literature review was compiled based on and supplementing,
where necessary, the ECCO UC 2011 guidelines. EPATUC (endorsed by ECCO)
was formed by 8 gastroenterologists, 2 surgeons and 2 general practitioners from throughout
Europe. Clinical scenarios reflecting practice were rated on a 9-point scale from 1 (extremely
inappropriate) to 9 (extremely appropriate), based on the expert's experience and the available
literature. After extensive discussion, all scenarios were re-rated at a two-day panel meeting.
Median and disagreement were used to categorize ratings into 3 categories: appropriate,
uncertain and inappropriate. Results: 718 clinical scenarios were rated, structured in 13
main clinical presentations: not refractory (n=64) or refractory (n=33) proctitis, mild to
moderate left-sided (n=72) or extensive (n=48) colitis, severe colitis (n=36), steroid-dependant
colitis (n=36), steroid-refractory colitis (n=55), acute pouchitis (n=96), maintenance of
remission (n=248), colorectal cancer prevention (n=9) and fulminant colitis (n=9). Overall,
100 indications were judged appropriate (14%), 129 uncertain (18%) and 489 inappropriate
(68%). Disagreement between experts was very low (6%). Conclusion: For the very first
time, explicit appropriateness criteria for therapy of UC were developed that allow both
specific and rapid therapeutic decision making and prospective assessment of treatment
appropriateness. Comparison of these detailed scenarios with patient profiles encountered
in the Swiss IBD cohort study indicates good concordance. EPATUC criteria will be freely
accessible on the internet (epatuc.ch).
options many of which are not evidence based. Supplementing available guidelines, which
are often broadly defined, consensus-based and generally not tailored to specifically reflect
the individual patient situation, we developed explicit appropriateness criteria to assist, and
improve treatment decisions. Methods: We used the RAND appropriateness method which
does not force consensus. An extensive literature review was compiled based on and supplementing,
where necessary, the ECCO UC 2011 guidelines. EPATUC (endorsed by ECCO)
was formed by 8 gastroenterologists, 2 surgeons and 2 general practitioners from throughout
Europe. Clinical scenarios reflecting practice were rated on a 9-point scale from 1 (extremely
inappropriate) to 9 (extremely appropriate), based on the expert's experience and the available
literature. After extensive discussion, all scenarios were re-rated at a two-day panel meeting.
Median and disagreement were used to categorize ratings into 3 categories: appropriate,
uncertain and inappropriate. Results: 718 clinical scenarios were rated, structured in 13
main clinical presentations: not refractory (n=64) or refractory (n=33) proctitis, mild to
moderate left-sided (n=72) or extensive (n=48) colitis, severe colitis (n=36), steroid-dependant
colitis (n=36), steroid-refractory colitis (n=55), acute pouchitis (n=96), maintenance of
remission (n=248), colorectal cancer prevention (n=9) and fulminant colitis (n=9). Overall,
100 indications were judged appropriate (14%), 129 uncertain (18%) and 489 inappropriate
(68%). Disagreement between experts was very low (6%). Conclusion: For the very first
time, explicit appropriateness criteria for therapy of UC were developed that allow both
specific and rapid therapeutic decision making and prospective assessment of treatment
appropriateness. Comparison of these detailed scenarios with patient profiles encountered
in the Swiss IBD cohort study indicates good concordance. EPATUC criteria will be freely
accessible on the internet (epatuc.ch).
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14/02/2013 16:11
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