Dr Sandborn and Prof. Peyrin-Biroulet

The inflammatory bowel diseases (IBD) diagnosed as Crohn’s disease and ulcerative colitis are chronic disabling conditions with an increasing incidence worldwide.¹ Although the management of IBD has changed considerably over the past two decades, with the most important trends being the advent of several therapeutic anti-tumor necrosis factor (TNF) antibodies,² several important questions concerning clinical treatment approaches remain. The first proceedings from a live Clinical Appraisal symposium were published online in Clinical Gastroenterology and Hepatology earlier (http://education.cghjournal.org/video.php?event_id=976&stage_id=5&vcs=1).³ Using the same international survey, leading faculty roundtable, and literature review-and-discussion methodology as was used in that appraisal, this second symposium was convened to address additional questions, including use of anti-TNF therapy during the operative period, thiopurines as monotherapy, whether anti-TNF agents possessed a disease-modifying effect, the safety of combination therapy, the withdrawal of therapy in patients in remission, and the potential place of anti-integrins in IBD therapy (Table 1). The main intention of this meeting was to provide a framework for future discussion and research on IBD.

For this second Clinical Appraisal an 8-member faculty was recruited and asked to draft 8 clinically important statements pertaining to these questions. Each of the 8 participants was then assigned one of the statements and asked to systematically review and summarize the evidence supporting and/or refuting that statement in preparation for presentation during the live symposium.

For each study chosen as relevant for review, the faculty member was ask to pay particular attention to the study’s methodology, the patients enrolled, and the outcomes pertaining to the assigned statement. Then following each presentation of a statement and literature review to the panel, all 8 participants discussed the evidence reviewed for and against the statement and voted anonymously using a 5-point voting scheme to evaluate both (1) the objective strength of the evidence and (2) what they felt their own levels of support for the statements to be (Table 1).

In addition to defining the level of evidence and support for each statement, the faculty also discussed and outlined what additional data they felt were required in order to further define the statement for future clinical use.

To provide further evidence of current clinical perspectives on these issues, a Web-based survey of international practicing gastroenterologists was conducted to determine their level of support for the same 8 clinical statements, using the same 5-point voting scheme to rate the 8 statements (Table 1). An e-mail invitation to participate in the electronic survey was sent to approximately 20,000 gastroenterologists, including 9781 members of the American Gastroenterological Association (AGA). The final response rate was 1.4% (284 surveys completed). The purpose of the survey was to provide a comparison of the responses of an international subset of practicing clinical gastroenterologists with the data-driven responses of the symposium faculty. Several gastroenterology studies have been reported using clinician survey-based data from less than 284 completed responses.^4,5

This on-line interactive article represents the proceedings of a faculty of gastroenterologists with focused research interest and extensive clinical experience in IBD whose goal was to assess the quality of evidence surrounding a number of challenging treatment scenario statements with important potential implications for clinical practice.