Report on the updated ECCO Guidelines on Therapeutics in Crohn’s Disease

This guidelines update was coordinated by Hannah Gordon, Tim Raine, Pår Myrelid and Michel Adamina. Work was divided into four working groups staffed by 38 IBD experts from 18 countries and three continents who were supported by professional methodologists and librarians. Expert authors included a specialist IBD nurse and dietitian, in recognition of the multidisciplinary needs of our patients. A total of six EFCCA patient representatives also participated, shaping the topics and GRADE outcomes and providing feedback during online voting rounds. 

The working groups (WG) were defined as follows: WG1: Induction and remission (WG lead: Uri Kopylov); WG2: Maintenance of remission and de-escalation (WG lead: Bram Verstockt); WG3: Management of perineal disease (WG lead, medical: Maria Chaparro; WG lead, surgical: Christianne Buskens); WG4: Surgery in abdominal CD (WG lead: Janindra Warusavitarne). 

This is the second ECCO CD treatment guideline to incorporate the GRADE methodology, building upon the 2020 manuscripts. Taking into account feedback received from clinicians, utmost consideration was given to making the present guidelines more actionable, including practice points supporting clinical decision-making. As in 2020, the medical management was developed with the GRADE methodology whereas the surgical manuscript (which included the medical management of perianal disease) worked with the Oxford Evidence Levels to account for the limited amount of RCTs and meta-analyses in this field. Both manuscripts, shortly to be published in JCC, include a total of 78 statements and eight practice points to inform and guide clinical management. 

The production of evidence-based guidelines requires a significant commitment of time and resources. First, participants were trained by methodologists in order to become proficient with the guideline’s methodology. Then, a thorough discussion of the 2020 guidelines at the face-to-face kick-off meeting in September 2022 identified areas where additional recommendations were required and topics where additional evidence was expected. The final PICO questions were defined, and included feedback from the six patients’ representatives. A targeted systematic search was performed for each PICO by librarians, followed by screening by two designated participants. Full text retrieval allowed creation of summary of findings tables. Grading of evidence completed the process, which was supported by professional methodologists. A total of three voting rounds were performed to achieve consensus, with statements achieving >80% agreement included within the final manuscripts. The second voting round was supplemented by feedback from ECCO National Representatives, patient representatives and additional reviewers. The final manuscript was drafted by the four coordinators and ultimately approved by all guidelines’ participants and the ECCO Governing Board. 

Development of these guidelines began in the aftermath of the COVID-19 pandemic. In this context, it also embodied a return to normality. In the name of all participants, IBD experts, patients, methodologists and staff involved, we are grateful for the opportunity to contribute and we hope that these updated ECCO Guidelines on Therapeutics in Crohn’s Disease will prove useful to the busy clinician.

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