Segundo Consenso Brasileiro de Manejo da Doença de Crohn em adultos: um consenso da Organização Brasileira de Doença de Crohn e Colite (GEDIIB)

IMBRIZI, Marcello; BAIMA, Júlio Pinheiro; AZEVEDO, Matheus Freitas Cardoso de; ANDRADE, Adriana Ribas; QUEIROZ, Natália Souza Freitas; CHEBLI, Júlio Maria Fonseca; CHEBLI, Liliane Andrade; ARGOLLO, Marjorie Costa; SASSAKI, Ligia Yukie; PARRA, Rogerio Serafim; QUARESMA, Abel Botelho; VIEIRA, Andrea; DAMIÃO, Adérson Omar Mourão Cintra; MORAES, Antonio Carlos da Silva; FLORES, Cristina; ZALTMAN, Cyrla; VILELA, Eduardo Garcia; MORSOLETTO, Eloá Marussi; GONÇALVES FILHO, Francisco de Assis; PENNA, Francisco Guilherme Cancela e; SANTANA, Genoile Oliveira; ZABOT, Gilmara Pandolfo; PARENTE, José Miguel Luz; COSTA, Marcia Henriques de Magalhães; ZERÔNCIO, Marco Antonio; MACHADO, Marta Brenner; CASSOL, Ornella Sari; KOTZE, Paulo Gustavo; FRÓES, Renata de Sá Brito; MISZPUTEN, Sender Jankiel; AMBROGINI JUNIOR, Orlando; SAAD-HOSSNE, Rogério; COY, Cláudio Saddy Rodrigues

Marcello IMBRIZI

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0001-5397-0084

Júlio Pinheiro BAIMA

methodology

literature review

recommendations decision making

writing and review

Universidade Nove de Julho, Bauru, SP, Brasil.

Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-4035-3113

Matheus Freitas Cardoso de AZEVEDO

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-5487-9418

Adriana Ribas ANDRADE

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual da Bahia, Salvador, BA, Brasil.

http://orcid.org/0000-0001-6012-2155

Natália Souza Freitas QUEIROZ

methodology

literature review

recommendations decision making

writing and review

Hospital Santa Cruz, Curitiba, PR, Brasil.

http://orcid.org/0000-0003-2857-0825

Júlio Maria Fonseca CHEBLI

methodology

literature review

recommendations decision making

writing and review

Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0003-1527-0663

Liliane Andrade CHEBLI

methodology

literature review

recommendations decision making

writing and review

Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0002-7875-1475

Marjorie Costa ARGOLLO

methodology

literature review

recommendations decision making

writing and review

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-9867-8861

Ligia Yukie SASSAKI

methodology

literature review

recommendations decision making

writing and review

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-7319-8906

Rogerio Serafim PARRA

methodology

literature review

recommendations decision making

writing and review

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

http://orcid.org/0000-0002-5566-9284

Abel Botelho QUARESMA

recommendations decision making

Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brasil.

http://orcid.org/0000-0002-3985-7402

Andrea VIEIRA

recommendations decision making

Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil.

http://orcid.org/0000-0003-1858-3446

Adérson Omar Mourão Cintra DAMIÃO

recommendations decision making

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-7584-7351

Antonio Carlos da Silva MORAES

recommendations decision making

Hospital Copa D’Or, São Paulo, SP, Brasil.

http://orcid.org/0000-0002-5533-5401

Cristina FLORES

recommendations decision making

Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0003-1623-4525

Cyrla ZALTMAN

recommendations decision making

Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-5236-6501

Eduardo Garcia VILELA

recommendations decision making

Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

http://orcid.org/0000-0002-5443-7553

Eloá Marussi MORSOLETTO

recommendations decision making

Hospital São Vicente, Curitiba, PR, Brasil.

http://orcid.org/0000-0001-9204-2651

Francisco de Assis GONÇALVES FILHO

recommendations decision making

Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.

http://orcid.org/0000-0003-0153-4349

Francisco Guilherme Cancela e PENNA

recommendations decision making

Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

http://orcid.org/0000-0002-2338-5367

Genoile Oliveira SANTANA

recommendations decision making

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-5936-9791

Gilmara Pandolfo ZABOT

recommendations decision making

Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0002-1253-4945

José Miguel Luz PARENTE

recommendations decision making

Universidade Federal do Piauí, Teresina, PI, Brasil.

http://orcid.org/0000-0003-4563-2784

Marcia Henriques de Magalhães COSTA

recommendations decision making

Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-5636-7501

Marco Antonio ZERÔNCIO

recommendations decision making

Promater - Hospital Geral, Natal, RN, Brasil.

http://orcid.org/0000-0002-1006-1101

Marta Brenner MACHADO

recommendations decision making

Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0003-2266-2542

Ornella Sari CASSOL

recommendations decision making

Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil.

http://orcid.org/0000-0003-0867-6593

Paulo Gustavo KOTZE

final review of the manuscript

Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil.

http://orcid.org/0000-0002-2053-5315

Renata de Sá Brito FRÓES

recommendations decision making

Gastromed, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-3256-4698

Sender Jankiel MISZPUTEN

recommendations decision making

Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil.

http://orcid.org/0000-0003-4487-5004

Orlando AMBROGINI JUNIOR

final review of the manuscript

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-3318-6246

Rogério SAAD-HOSSNE

methodology

literature review

recommendations decision making

writing and review

Universidade Nove de Julho, Bauru, SP, Brasil.

http://orcid.org/0000-0002-8166-0304

Cláudio Saddy Rodrigues COY

final review of the manuscript

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0002-0916-4138

Corresponding author: Marcello Imbrizi. E-mail: marcelloimbrizi@gmail.com

Declared conflict of interest of all authors: The authors receive support for conferences, lectures, or clinical research at the aforementioned laboratories. Abel Botelho Quaresma: AbbVie, Apsen, Janssen; Gilmara Pandolfo Zabot: Abbvie, Takeda, Janssen; Júlio Pinheiro Baima: Janssen, Takeda, Pfizer; Marcello Imbrizi: Abbvie, Takeda, Janssen; Ornella Sari Cassol: Janssen, Abbvie, Takeda, Nestle, Buhlmann; Paulo Gustavo Kotze: Abbvie, Takeda, Pfizer, Janssen; Rogerio Serafim Parra: Takeda, Pfizer, Janssen; Matheus Freitas Cardoso de Azevedo: Janssen, Takeda, Pfizer, Abbvie; Natália Souza Freitas Queiroz: Abbvie, Takeda, Janssen; Júlio Maria Fonseca Chebli: Abbott, Abbivie, Jansen, Takeda; Liliane Andrade Chebli: Jansen, Takeda; Marjorie Costa Argollo: Janssen, Takeda, Pfizer, Abbvie, Sandoz; Ligia Yukie Sassaki: Janssen, Takeda; Adérson Omar Mourão Cintra Damião: Janssen, Takeda, Abbvie, Ferring; Antonio Carlos da Silva Moraes: Abbvie, Takeda, Jansen, FQM, Pfizer; Cristina Flores: Takeda, Janssen, Pfizer, Abbvie; Cyrla Zaltman: Takeda, Abbvie, Janssen, Pfizer, Ferring; Eduardo Garcia Vilela: Ferring; Eloá Marussi Morsoletto: Takeda, Janssen; Francisco de Assis Gonçalves Filho: Takeda, Janssen; Francisco Guilherme Cancela e Penna: Abbvie, Janssen, Novartis, Takeda; Genoile Oliveira Santana: Abbvie, Ferring, Janssen, Pfizer, Takeda; José Miguel Luz Parente: Abbvie, Janssen, Takeda, Pfizer ; Marcia Henriques de Magalhães Costa: Janssen, Abbvie, Takeda, Pfizer ; Marco Antonio Zerôncio: Takeda, Janssen, Abbvie; Marta Brenner Machado: Janssen, Abbvie, Takeda , Ferring, Pfizer; Renata de Sá Brito Fróes: Janssen, Takeda, Abbvie, Pfizer; Orlando Ambrogini Junior: Abbvie, Janssen, Pfizer, Takeda.

Universidade Estadual de Campinas, Campinas, SP, Brasil.

Universidade Nove de Julho, Bauru, SP, Brasil.

Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

Universidade Estadual de São Paulo, São Paulo, SP, Brasil.

Universidade Estadual da Bahia, Salvador, BA, Brasil.

Hospital Santa Cruz, Curitiba, PR, Brasil.

Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil.

Universidade Federal de São Paulo, São Paulo, SP, Brasil.

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brasil.

Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil.

Hospital Copa D’Or, São Paulo, SP, Brasil.

Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil.

Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

Hospital São Vicente, Curitiba, PR, Brasil.

Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.

Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil.

Universidade Federal do Piauí, Teresina, PI, Brasil.

Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil.

Promater - Hospital Geral, Natal, RN, Brasil.

Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.

Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil.

Gastromed, São Paulo, SP, Brasil.

Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil.

Variable	Options	Points
General well-being*	Very well	0
	Slightly below par	1
	Poor	2
	Very poor	3
	Terrible	4
Abdominal pain*	None	0
	Mild	1
	Moderate	2
	Severe	3
Number of liquid/soft stools*		1 per stool
Abdominal mass	None	0
	Dubious	1
	Definite	2
	Definite and tender	3
Complications
Arthralgia
Uveitis
Erythema nodosum
Aphthous ulcers
Pyoderma gangrenosum
Anal fissures
New fistula
Abscess

	Weighing factor
1) Sum of the number of liquid or soft stools for the previous seven days	x2
2) Abdominal pain (none = 0; mild = 1; moderate = 2; severe = 3)	x5
Consider the total sum of individual data during the previous week
3) General well-being (excellent = 0; good = 1; average = 2; bad =3; terrible = 4)	x7
Consider the total sum of individual data during the previous week
4) Number of associated symptoms (list by category)
Arthralgia/arthritis
Inflammation of the iris/uveitis
erythema nodosum/oral aphthae	x20 (Maximum value =120)
Anal fissure, fistulae, or abscesses
other types of fistulae
fever
Use of antidiarrheic drugs (No = 0; Yes = 1)	x30
Abdominal mass (none = 0; questionable = 2; definite = 5)	x10
Absolute deviation of hematocrit: men 47-Ht; women 42-Ht (subtract instead of adding if patient’s Ht is higher than standard)	x6
Weight*: percentage deviation from standard weight (subtract instead of adding if patient’s weight is higher than expected)
*Expected or ideal weight = height (m)2 x 25.5=_____ kg (men)	x1
Height (m)2 x 22.5=_________ kg (women)
Total CDAI score
≤150 = Remission
150-250 = Mild
250-350 = Moderate
350 = Severe


Size of ulcers (diameter)	Absent	0
	Aphthous ulcers, 0.1-0.5 cm	1
	Large ulcers, 0.5-2 cm	2
	Very large ulcers, > 2 cm	3
Ulcerated surface	None	0
	<10% of the segment	1
	10-30% of the segment	2
	>30% of the segment	3
Affected surface	None	0
	< 50% of the segment	1
	50-75% of the segment	2
	75% of the segment	3
Presence of narrowing	None	0
	Single, passable by the scope	1
	Multiple, passable by the scope	2
	Not passable, frank stenosis	3
	Total SES-CD =

Drug	Induction dose	Maintenance dose
Corticosteroids	Budesonide (mild ileal and/or right colon commitment)	Maintenance dose is not indicated. For prednisolone use, after 14 days of full dose, if patient with clinical improvement, consider tapering at 5 mg/week over an 8-to 12-week period
	9 mg/day PO for 2-3 months
	Prednisolone 0.50 to 0.75 mg/kg PO with a maximum daily dose of 60 mg
Immunosuppressants	Azathioprine: 1,5-2,5 mg/kg/day PO	Azathioprine: 1,5-2,5 mg/kg/day PO
	6-mercaptopurine: 1-1.5 mg/kg/day PO	6-mercaptopurine: 1-1.5 mg/kg/day PO
	Methotrexate: 25 mg/week SC or IM for 12 weeks	Methotrexate: 15 mg/week SC or IM
Anti-TNF	Infliximab 10 mg/mL (10 mL/unit): 5 mg/kg	Infliximab 10 mg/mL (10 mL/unit): 5 mg/kg IV every 8 weeks or Infliximab 120 mg SC every 2 weeks from week 6
	IV at 0, 2, and 6 weeks or Infliximab 5 mg/kg	Optimized dose: 10 mg/kg every 8 weeks or 5 mg/kg every 4 weeks
	IV at 0 and 2 weeks	Adalimumab 40 mg (syringe or pen) or 80 mg: 40 mg SC every 2 weeks
	Adalimumab 40 mg (syringe or pen) or 80 mg (pen): 160 mg SC and then 80mg after 2 weeks	Optimized dose: 40 mg SC weekly or 80 mg SC every 2 weeks
	Certolizumab pegol 200 mg/unit (syringe): 400 mg SC at weeks 0, 2 and 4	Certolizumab pegol 200 mg/unit (syringe): 400 mg SC every 4 weeks
Anti-integrin	Vedolizumab 300 mg/unit: 300 mg IV at weeks 0, 2 and 6	Vedolizumab 300 mg/unit: 300 mg IV every 8 weeks (vedolizumab): or 108 mg SC every 2 weeks starting after the second or third intravenous induction dose
	An additional dose at week 10 may be indicated in those patients with a suboptimal response	Optimized dose: 300 mg IV every 4 weeks or 108 mg SC weekly (off label)
Anti-interleukin	Ustekinumab 130 mg/26 mL	Ustekinumab 90 mg/unit: 90mg SC every 8 or 12 weeks
	55 kg or less: 260 mg	Optimized dose in patients with 90 mg every 12 weeks: 90 mg SC every 8 weeks (on-label)
	55 kg to 85 kg: 390 mg more than 85 kg: 520 mg	Optimized dose in patients with 90mg every 8 weeks: 90 mg SC every 4 weeks (off-label)Risankizumab*
	Risankizumab* 600 mg/unit: 600 mg IV at weeks 0, 4 and 8	360 mg/2.4 mL (syringe): 360 mg SC at week 12 and then every 8 weeks

Databases	Search strategy	Results (titles)
Pubmed	(“inflammatory bowel disease” [Title] OR “IBD” [Title] OR “crohn” [Title]) AND (“treatment” [Title/Abstract] OR “management” [Title/Abstract] OR “monitoring” [Title/Abstract]) AND (“consensus” [Title] OR “guidelines” [Title]) AND ((y_5[Filter]) AND (english [Filter]))	85
Systematic Literature Reviews with meta-analysis	((“inflammatory bowel disease” [Title] OR “IBD” [Title] OR “crohn” [Title]) AND (“treatment” [Title/Abstract] OR “management” [Title/Abstract] OR “monitoring” [Title/Abstract])) AND ((meta-analysis [Filter]) AND (english [Filter]))	318

Authors, year	Title	Domain 1 score	Domain 2 score	Domain 3 score	Domain 4 score	Domain 5 score	Domain 6 score	Overall assessment
Amiot et al., 2021	Clinical guidelines for the management of inflammatory bowel disease: update of a French national consensus.	16.7	55.6	35.4	38.9	41.7	50.0	39.7
Bonnaud et al., 2020	Monitoring of inflammatory bowel disease in 2019: A French consensus for clinical practice.	61.1	72.2	45.8	77.8	58.3	58.3	62.3
Bouchard et al., 2019	How to manage anal ulcerations and anorectal stenosis in Crohn’s disease: algorithm-based decision making: French National Working Group Consensus 2018.	33.3	27.8	39.6	83.3	54.2	83.3	53.6
Cheifetz et al., 2021	A Comprehensive Literature Review and Expert Consensus Statement on Therapeutic Drug Monitoring of Biologics in Inflammatory Bowel Disease.	100.0	88.9	62.5	88.9	62.5	75.0	79.6
Clarke et al., 2019	Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments.	77.8	0.0	20.8	66.7	41.7	91.7	49.8
Feuerstein et al., 2021	AGA Clinical Practice Guidelines on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn’s Disease.	94.4	72.2	58.3	83.3	20.8	100.0	71.5
Gomollon et al., 2017	3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management.	61.1	50.0	54.2	83.3	62.5	58.3	61.6
Greuter et al., 2020	Therapeutic Drug Monitoring to Guide Clinical Decision Making in Inflammatory Bowel Disease Patients with Loss of Response to Anti-TNF: A Delphi Technique-Based Consensus.	72.2	61.1	47.9	83.3	54.2	83.3	67.0
Khan et al., 2019	New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease.	66.7	50.0	43.8	83.3	62.5	66.7	62.2
Lamb et al., 2019	British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.	100.0	100.0	100.0	100.0	95.8	100.0	99.3
Matsuoka et al., 2018	Evidence-based clinical practice guidelines for inflammatory bowel disease.	83.3	61.1	66.7	83.3	50.0	66.7	68.5
Nakase et al., 2021	Evidence-based clinical practice guidelines for inflammatory bowel disease 2020.	83.3	72.2	81.3	83.3	50.0	66.7	72.8
Papamichael et al., 2019	Appropriate Therapeutic Drug Monitoring of Biologic Agents for Patients with Inflammatory Bowel Diseases.	83.3	72.2	60.4	77.8	58.3	58.3	68.4
Park et al., 2017	Second Korean guidelines for the management of Crohn’s disease.	88.9	72.2	85.4	88.9	58.3	58.3	75.3
Qian et al., 2021	Chinese consensus on diagnosis and treatment in inflammatory bowel disease (2018, Beijing).	72.2	61.1	56.3	50.0	41.7	50.0	55.2
Steinhart et al., 2019	Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn’s Disease: The Toronto Consensus.	77.8	72.2	79.2	72.2	66.7	83.3	75.2
Torres et al., 2020	ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment.	83.3	94.4	85.4	83.3	62.5	75.0	80.7
Wei et al., 2017	Management of Crohn’s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.	55.6	38.9	25.0	61.1	37.5	8.3	37.7
Syal et al., 2021	Health Maintenance Consensus for Adults with Inflammatory Bowel Disease.	66.7	50.0	56.3	61.1	37.5	58.3	55.0
Lichtenstein et al., 2018	ACG Clinical Guideline: Management of Crohn’s Disease in Adults.	55.6	16.7	56.3	83.3	37.5	66.7	52.7
Panaccione et al., 2019	Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Luminal Crohn’s Disease.	83.3	72.2	95.8	100.0	66.7	100.0	86.3
Turner et al., 2021	STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD.	61.1	72.2	64.6	61.1	50.0	91.7	66.8
Gionchetti et al., 2017	Use of corticosteroids and immunosuppressive drugs in inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease.	55.6	61.1	60.4	83.3	45.8	66.7	62.2
Ran et al., 2021	Asian Organization for Crohn’s and Colitis and Asia Pacific Association of Gastroenterology practice recommendations for medical management and monitoring of inflammatory bowel disease in Asia.	22.2	38.9	16.7	61.1	29.2	50.0	36.3

Author	Alipour	Attauabi	Chandar	Chande	Chande	Chande	Chen	Cholapranee	Coward	Da	Davies	Hazlewood	Kawalec	Kopylov
Year	2021	2021	2015	2016	2015	2013	2021	2017	2017	2013	2019	2015	2016	2014
1. Did the research questions and inclusion criteria for the review include the components of PICO?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes
*2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?	No	No	No	Yes	Yes	Yes	Yes	No	No	No	Yes	No	No	No
3. Did the review authors explain their selection of the study designs for inclusion in the review?	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
*4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Yes	Yes	Yes	Yes
5. Did the review authors perform study selection in duplicate?	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
6. Did the review authors perform data extraction in duplicate?	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
*7. Did the review authors provide a list of excluded studies and justify the exclusions?	No	Partial	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
8. Did the review authors describe the included studies in adequate detail?	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Partial	Yes	Yes	Yes	Yes
10. Did the review authors report on the sources of funding for the studies included in the review?	No	No	No	Yes	Yes	Yes	No	No	No	No	Yes	No	Yes	No
*11. If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes
*13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?	Yes	No	Yes	Yes	Yes	Yes	No	No	No	No	Yes	Yes	No	Yes
14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No	No	Yes
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	Yes	No	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial
Rating overall	Low	Critically Low	Low	High	High	High	Low	Critically Low	Critically Low	Critically Low	High	Critically Low	Critically Low	Low

Author	Kuenzig	Lim	Limketkai	Macaluso	Miligkos	Moja	Patel	Rezaie	Rolfe	Schreiber	Singh	Singh	Singh
Year	2014	2016	2020	2020	2016	2015	2014	2015	2006	2018	2014	2018	2021
1. Did the research questions and inclusion criteria for the review include the components of pico?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	No	Partial	Partial	No
3. Did the review authors explain their selection of the study designs for inclusion in the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
5. Did the review authors perform study selection in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Yes
6. Did the review authors perform data extraction in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes	Yes	Yes
*7. Did the review authors provide a list of excluded studies and justify the exclusions?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Partial
8. Did the review authors describe the included studies in adequate detail?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial
*9. Did the review authors use a satisfactory technique for assessing the risk of bias (rob) in individual studies that were included in the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Partial	Yes
10. Did the review authors report on the sources of funding for the studies included in the review?	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
*11. If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
12. If meta-analysis was performed, did the review authors assess the potential impact of rob in individual studies on the results of the meta-analysis or other evidence synthesis?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	No	Yes
*13. Did the review authors account for rob in individual studies when interpreting/ discussing the results of the review?	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	No	No	No	No
14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
*15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Rating overall	High	High	High	Low	Critically low	High	High	High	High	Critically low	Critically low	Low	Low

[1] Corresponding author: Marcello Imbrizi. E-mail: marcelloimbrizi@gmail.com

P	Adults (≥18 years) with mild to moderate active CD
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆ Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Not applicable
Type of study	Consensus and/or guidelines limited to the 2016-2021

P	Adults (≥18 years) with moderate to severe active CD
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆ Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to 2016-2021

P	Adults (≥18 years) with mild to moderate active CD
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆ Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to 2016-2021

P	Adults (≥18 years) with moderate to severe active CD
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆ Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to 2016-2021

P	Adults (≥18 years) with perianal CD
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆ Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆ Anti-Integrin (vedolizumab)
	◆ Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to 2016-2021

Brasil

Brasil

Segundo Consenso Brasileiro de Manejo da Doença de Crohn em adultos: um consenso da Organização Brasileira de Doença de Crohn e Colite (GEDIIB)

RESUMO

Contexto:

Objetivo:

Métodos:

Resultados e conclusão:

P	Adults (≥18years) with active CD
I	Not applicable
C	Not applicable
O	Criteria used to assess the efficacy of treatment:
	• Clinical response
	• Clinical remission
	• Endoscopic response
	• Endoscopic remission
	• Histological remission
	• Corticosteroid-free clinical remission
	• Improves quality of life
	• Adverse events
	• Others found in the literature
Type of study	Consensus and/or guidelines limited to 2016-2021