First explicit criteria to decide on the appropriateness of therapy of ulcerative colitis: the European EPATUC panel


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First explicit criteria to decide on the appropriateness of therapy of ulcerative colitis: the European EPATUC panel
Titre de la conférence
7th Congress of ECCO, European Crohn's and Colitis Organisation
Pittet V., Vader J.P., Gonvers J.J., Maillard M., Schoepfer A.M., Felley C., Mottet C., Michetti P., Froehlich F.
Barcelona, Spain, February 16-18, 2012
Statut éditorial
Date de publication
Journal of Crohn's and Colitis
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 7 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 (D) were used to
categorize ratings into 3 categories: appropriate (A), uncertain
(U) and inappropriate (I).
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%).
Conclusions: 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 (
Open Access
Création de la notice
14/02/2013 17:10
Dernière modification de la notice
20/08/2019 16:27
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