Clinician management of patients with Crohn's-related perianal fistulas: results of a multispecialty case-based survey.

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Gregory David Salinas, Emily Belcher, Sylvie Stacy, Pradeep P Nazarey, Susan E Cazzetta
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Abstract

Objective: A case-based survey was conducted to identify practice patterns and knowledge gaps in the management of Crohn's perianal fistulas (CPF) and to further understand approaches to CPF management within the USA by healthcare professionals (HCPs) from different specialties.

Methods: The web-based survey, comprising two hypothetical patient case vignettes (case 1: initial CPF presentation and progression to partial response; case 2: recurrent CPF), was distributed September-October 2020 to US gastroenterologists (GEs) and colorectal surgeons (CRSs), and nurse practitioners (NPs) and physician assistants (PAs) from these specialties, who managed ≥1 patient with CPF/month. The survey included questions on clinician evaluation and treatment approach.

Results: Across surveyed HCPs (127 GEs, 63 GE NP/PAs, 78 CRSs and 14 CRS NP/PAs), 39% stated that they did not use any standard system for classifying/scoring CPF. On initial CPF presentation, ≥98% of HCPs reported a requirement for additional diagnostic/imaging evaluation before proceeding with medical management; GEs preferred pelvic MRI (70%) and CRSs preferred examination under anaesthesia (62%). Preferred management after partial response to initial treatment varied by HCP type (23% GEs vs 71% CRSs preferred continuation of current medical therapy; 60% vs 38% preferred seton continuation; 24% vs 41% preferred seton removal, respectively). For recurrent CPF, most HCPs chose to switch from infliximab to another antitumour necrosis factor agent, while most GEs opted to switch to a different monoclonal antibody. In contrast, 44% of GEs and 27% of CRSs opted to proceed with surgery.

Conclusion: Lack of consensus in CPF management requires improved coordination in treatment approaches among specialists.

临床医生对克罗恩病相关肛周瘘患者的管理:一项多专业病例调查的结果
目的:通过一项基于病例的调查,确定克罗恩肛周瘘管(CPF)管理的实践模式和知识差距,并进一步了解美国不同专业的医疗保健专业人员(HCPs)管理CPF的方法。方法:基于网络的调查,包括两个假设的患者病例(病例1:最初的CPF表现和进展到部分反应;病例2:复发性CPF),于2020年9月至10月分发给来自这些专业的美国胃肠病学家(GEs)和结直肠外科医生(CRSs)以及执业护士(NPs)和医师助理(PAs),他们每月管理≥1例CPF患者。调查的问题包括临床医生的评价和治疗方法。结果:在调查的HCPs(127个GE, 63个GE NP/PAs, 78个CRSs和14个CRS NP/PAs)中,39%的人表示他们没有使用任何标准系统来分类/评分CPF。在初始CPF表现中,≥98%的HCPs报告在进行医疗管理之前需要进行额外的诊断/成像评估;GEs首选骨盆MRI (70%), CRSs首选麻醉下检查(62%)。初始治疗部分缓解后的首选管理因HCP类型而异(23%的GEs vs 71%的CRSs);60% vs 38%的人更喜欢延续;分别为24%和41%)。对于复发性CPF,大多数HCPs选择从英夫利昔单抗切换到另一种抗肿瘤坏死因子药物,而大多数ge选择切换到不同的单克隆抗体。相比之下,44%的ge和27%的CRSs选择继续进行手术。结论:在CPF管理中缺乏共识,需要加强专家之间的治疗方法协调。
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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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