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- CDAI, Crohn’s Disease Activity Index
- ECCO, European Crohn’s and Colitis Organization
- IBD, inflammatory bowel disease
When is a consensus not a consensus?
Eduard Stange and Simon Travis1 are to be congratulated on their magnum opus encompassing 234 statements and 727 references pertaining to the diagnosis and management of Crohn’s disease. The aim of the consensus was not to “supersede guidelines of different countries”, but to “promote a European perspective on the management of Crohn’s disease” under the auspices of the European Crohn’s and Colitis Organization (ECCO). ECCO is a forum established in 2000 for specialists interested in inflammatory bowel disease (IBD) to promote European views, clinical trials and specialist training in IBD. We agree with many, if not most, of the statements and recommendations, and note that the European consensus with regard to diagnosis and management of Crohn’s disease is substantially aligned with practice guidelines from the US.2,3
The methods (strategy) of the Consensus entailed five steps. Fourteen separate topics were assigned to 13 working parties whose chairmen developed questions that were distributed to the working parties. The working parties dealt with the questions on the basis of their experience and evidence from the literature (gained from a systematic literature search). An evidence level was graded (1–5) according to the guidelines of the Oxford Centre for Evidence Based Medicine (Oxford, UK). Provisional guideline statements were then written by the chairmen and circulated among the working parties, which met, first, in Prague at the 2004 United European Gastroenterology Week Conference, where 61 participants from 20 countries gathered to agree on the final versions of each guideline statement. The participants continued to discuss the individual statements until a consensus (>80% agreement) was reached. Each statement was then given a recommendation grade (A–D) on the basis of the level of evidence, and a final document for each topic was written by the chairmen in conjunction …