Diagnosing Crohn's disease in presumed cryptoglandular perianal fistulas: an expert Delphi consensus on early identification of patients at risk of Crohn's disease in perianal fistulas (PREFAB)
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View abstract on PubMed
Summary
This summary is machine-generated.A new clinical decision tool was developed to identify Crohn's disease (CD) in patients with perianal fistulas (PAF). It includes screening criteria and an algorithm for diagnosis, aiding in early detection and management.
Area Of Science
- Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease
Background
- Perianal fistulas (PAF) can indicate underlying Crohn's disease (CD).
- Accurate and timely diagnosis of CD in PAF patients is crucial for effective management.
- Existing diagnostic tools may lack comprehensive criteria for identifying CD in this population.
Purpose Of The Study
- To achieve international consensus on a novel clinical decision tool.
- To establish criteria for identifying or excluding Crohn's disease in patients presenting with perianal fistulas.
- To develop a practical algorithm for the diagnostic work-up of suspected CD in PAF patients.
Main Methods
- A three-round Delphi study involving international experts in proctology and inflammatory bowel disease.
- Round 1: Anonymous electronic survey on clinical characteristics, fecal calprotectin (FCP) use, and diagnostic work-up.
- Rounds 2/3: Virtual consensus meetings to refine and finalize statements, with consensus defined as ≥70% agreement.
Main Results
- Consensus reached on 12 statements, forming a new clinical decision tool.
- Recommendations include screening all PAF patients and referral for colonoscopy if FCP levels are elevated (≥150 mcg/g) or major clinical criteria are met.
- Defined clinical criteria suggestive of CD and an algorithm for diagnostic work-up and follow-up were established.
Conclusions
- International consensus achieved on a new clinical decision tool for identifying or excluding Crohn's disease in perianal fistula patients.
- The developed tool and algorithm provide a practical approach to diagnosing CD in this specific patient group.
- This consensus facilitates earlier and more accurate diagnosis, potentially improving patient outcomes.
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