title: Appropriateness of early management of newly diagnosed Crohn's disease in a European population-based cohort.
abstract: OBJECTIVE
  The European Panel on the Appropriateness of Crohn's disease Therapy (EPACT) has developed appropriateness criteria. We have applied these criteria retrospectively to the population-based inception cohort of Crohn's disease (CD) patients of the European Collaborative Study Group on Inflammatory Bowel Disease (EC-IBD).
  
  
  METHODS
  A total of 426 diagnosed CD patients from 13 European centers were enrolled at the time of diagnosis (first flare, naive patients). We used the EPACT definitions to identify 247 patients with active luminal CD. We then assessed the appropriateness of the initial drug prescription according to the EPACT criteria.
  
  
  RESULTS
  Among the cohort patients 163 suffered from mild-to-moderate CD and 84 from severe CD. Among the mild-to-moderate disease group, 96 patients (59%) received an appropriate treatment, whereas for 66 patients (40%) the treatment was uncertain and in one case (1%) inappropriate. Among the severe disease group, 86% were treated medically and 14% required surgery. 59 (70%) were appropriately treated, whereas for one patient (1%) the procedure was considered uncertain and for 24 patients (29%) inappropriate.
  
  
  CONCLUSIONS
  Initial treatment was appropriate in the majority of cases for non-complicated luminal CD. Inappropriate or uncertain treatment was given in a significant minority of patients, with an increased potential risk of adverse events.
authors.affiliation: Department of Gastroenterology & Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. p.juillerat@partners.org
authors.forename: Pascal
authors.initials: P
authors.lastname: Juillerat
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Christian
authors.initials: C
authors.lastname: Mottet
authors.forename: Christian
authors.initials: C
authors.lastname: Felley
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Gonvers
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Vader
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
authors.forename: Frank L
authors.initials: FL
authors.lastname: Wolters
authors.forename: Reinhold W
authors.initials: RW
authors.lastname: Stockbrügger
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003424:Crohn Disease / Q000175:diagnosis* / Q000628:therapy*; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies