J GastroenterolJSGEThe Japanese Societyhttps:doi.org/10.1007/s00535-023-01958-z838of GastroenterologyREVIEWTreatment escalation and de-escalation decisions in Crohn'sdisease:Delphi consensus recommendations from Japan,2021Hiroshi Nakase'.Motohiro Esaki2.Fumihito Hirai3.Taku Kobayashi.Katsuyoshi Matsuokas.Minoru Matsuura Makoto Naganuma?.Masayuki Saruta.Kiichiro Tsuchiya.Motoi Uchino1.Kenji Watanabe1.Tadakazu Hisamatsu.the TRADE consensus groupReceived:29 September 2022/Accepted:8 January 2023The Author(s)2023Abstractdefined topics.Results were assessed for relevant studiesBackground We aimed to develop criteria for treatmentwith preference given to data from randomized,controlledintensification in patients with (1)luminal Crohn's diseasestudies.For each question,a core panel of 12 gastroen-(CD),(2)CD with perianal disease and/or fistula,(3)CDterologists defined the treatment target and developedwith small bowel stenosis,(4)in the postoperative setting,statements,based on the literature,current guidelines,andand(5)for discontinuing or reducing the dose of treatmentrelevant additional studies.The evidence supporting eachin patients with CD.statement was graded using the Oxford Centre for Evi-Methods PubMed and Embase were searched for studiesdence-Based Medicine:Levels of Evidence (March 2009).published since 1998 which may be relevant to the fiveA modified Delphi process was used to refine statementsand gain agreement from 54 Japanese specialists at in-person and online meetings conducted between OctoberThe members of the TRADE consensus group are listed in“Acknowledgements”2020 and April 2021.☒Hiroshi NakaseMotoi Uchinohiro_nakase@sapmed.ac.jp;uchino2s @hyo-med.ac.jphiropynakase@gmail.comKenji Watanabe☒Tadakazu Hisamatsuke-watanabe@hyo-med.ac.jpthisamatsu@ks.kyorin-u.ac.jpMotohiro EsakiDepartment of Gastroenterology and Hepatology,Sapporomesaki0l@cc.saga-u.ac.jpMedical University School of Medicine.South-1.West-16.Chuo-Ku,Sapporo,Hokkaido 060-8543,JapanFumihito Hirai2fuhirai@cis.fukuoka-u.ac.jpDivision of Gastroenterology,Department of InternalMedicine,Faculty of Medicine,Saga University,Saga,JapanTaku Kobayashi3kobataku@insti.kitasato-u.ac.jpDepartment of Gastroenterology and Medicine,Faculty ofMedicine,Fukuoka University,Fukuoka,JapanKatsuyoshi Matsuokamatsuoka@fk2.so-net.ne.jpCenter for Advanced IBD Research and Treatment.KitasatoUniversity,Kitasato Institute Hospital,Tokyo,JapanMinoru Matsuurammatsuura@ks.kyorin-u.ac.jpDivision of Gastroenterology and Hepatology,Department ofInternal Medicine,Toho University Sakura Medical Center,Makoto NaganumaSakura,Chiba,Japannaganuma@hirakata.kmu.ac.jpDepartment of Gastroenterology and Hepatology,KyorinMasayuki SarutaUniversity School of Medicine,6-20-2 Shinkawa,Mitaka-m.saruta@jikei.ac.jpShi.Tokyo 181-8611,JapanKiichiro Tsuchiyakii.gast@md.tsukuba.ac.jpPublished online:11 February 2023②Springer
