Mucosal Healing Predicts Sustained Clinical Remission in Patients With Early-Stage Crohn's Disease

Department of Gastroenterology, H.-Hartziekenhuis Roeselare-Menen vzw, Roeselare, Belgium.
Gastroenterology (Impact Factor: 13.93). 10/2009; 138(2):463-8; quiz e10-1. DOI: 10.1053/j.gastro.2009.09.056
Source: PubMed

ABSTRACT Few prospective data are available to support the clinical relevance of mucosal healing in patients with Crohn's disease. This study examined whether complete healing, determined by endoscopy, predicts a better outcome in Crohn's disease.
One-hundred thirty-three newly diagnosed and treatment-naïve Crohn's disease patients were given either a combination of immunosuppressive therapy (azathioprine) and 3 infusions of infliximab or treatment with conventional corticosteroids. Patients given azathioprine were given repeated doses of infliximab for relapses, patients given corticosteroids were given azathioprine in cases of corticosteroid dependency and infliximab only if azathioprine failed. A representative subset of 49 patients from the initially randomized cohort underwent ileocolonoscopy after 2 years of therapy. Correlation analysis was performed between different clinical parameters including endoscopic activity (Simple Endoscopic Score) and clinical outcome 2 years after this endoscopic examination. Data were available from 46 patients 3 and 4 years after therapy began.
Complete mucosal healing, defined as a simple endoscopic score of 0 after 2 years of therapy, was the only factor that predicted sustained, steroid-free remission 3 and 4 years after therapy was initiated; it was observed in 17 of 24 patients (70.8%) vs 6 of 22 patients with lesions detected by endoscopy (27.3%, Simple Endoscopic Score >0) (P = .036; odds ratio = 4.352; 95% confidence interval, 1.10-17.220). Fifteen of 17 patients with mucosal healing at year 2 maintained in remission without further infliximab infusions during years 3 and 4 (P = .032; odds ratio = 4.883; 95% confidence interval, 1.144-20.844).
Complete mucosal healing in patients with early-stage Crohn's disease is associated with significantly higher steroid-free remission rates 4 years after therapy began.

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    • "Endoscopic findings have a major influence on disease outcomes in both CD [5] [6] [7] [8] and UC [9] [10] [11] [12] when the most severe endoscopic lesions are present. More recently, treatment-induced healing of mucosal lesions has been associated with more favourable long-term IBD courses [13] [14] [15] [16] [17] [18]. These observations have led to inclusion of endoscopic outcomes in more recent clinical trials as therapeutic endpoints [14,19–23]. "
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    ABSTRACT: Background Endoscopic activity has become a therapeutic endpoint in inflammatory bowel disease. Aim of this study was to evaluate inter-observer agreement for endoscopic scores in a real-life setting. Methods 14 gastroenterologists with experience in inflammatory bowel disease care and endoscopic scoring reviewed videos of ulcerative colitis (n = 13) and postoperative (n = 10) and luminal (n = 8) Crohn's disease. The Mayo subscore for ulcerative colitis, Rutgeerts score for postoperative Crohn's disease, Crohn's disease endoscopic index of severity (CDEIS), and the simple endoscopic score-Crohn's disease (SES-CD) for luminal Crohn's disease were calculated. A subset of five endoscopic clips were assessed by 30 general gastroenterologists without specific experience in endoscopic scores. Kappa statistics and intraclass correlation coefficients were used to measure agreement. Results Mayo subscore agreement was suboptimal: kappas were 0.53 (95% confidence interval 0.47–0.56) and 0.71 (0.67–0.76) for the two groups. Rutgeerts score agreement was fair: kappas were 0.57 (0.51–0.65) and 0.67 (0.60–0.72). Agreements for CDEIS and SES-CD were good: intraclass correlation coefficients for the two groups were 0.83 (0.54–1.00) and 0.67 (0.36–0.97) for CDEIS and 0.93 (0.76–1.00) and 0.68 (0.35–0.97) for SES-CD, respectively. Conclusion The reproducibility of endoscopic scores in inflammatory bowel disease remains suboptimal, which could potentially have major effects on therapeutic choices.
    Digestive and Liver Disease 11/2014; 46(11). DOI:10.1016/j.dld.2014.07.010 · 2.89 Impact Factor
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    • "The diagnosis of CD was based on published international criteria [5]. ES and AS CD were defined according with the duration of the disease, as previously described [20] [21] [22], following these criteria: Early = first attack of CD in a patient with no previous history of any gastrointestinal symptoms or surgery; Advanced = CD in a patient with at least five years history from the time of initial diagnosis and with persistent clinical activity requiring immunosuppressors, immunomodulators, steroids or surgery. ES CD patients had never received corticosteroids , antimetabolites or biological therapy and serum was collected within 3 months from the diagnoses (median 1 month). "
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    ABSTRACT: Crohn's disease (CD) represents a highly debilitating disease of difficult diagnosis and increasing incidence. Serum protein profiling of early stage Crohn's disease (ES) CD was investigated in order to improve the comprehension of the very early pathologic mechanisms and to support the difficult diagnostic procedures currently available. Inflammatory proteins and complement 3 chain C (C3c) were over-represented during ES CD, clusterin, retinol binding protein, α1-microglobulin and transthyretin were under-represented. A C3c isoform was found to be present only during ES CD. By now, lack of specific antibodies to detect isoforms made it impossible to perform alternative validation.
    06/2014; 3. DOI:10.1016/j.euprot.2014.02.010
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    • "Because it has been reported that more than 75% of patients with Crohn's disease have an active lesion in the small intestine, and one third of patients with Crohn's disease have an active lesion only in the small intestine [3], it is important in determining therapeutic strategy to diagnose lesions of Crohn's disease in the small intestine precisely. Furthermore, in recent years, biologics have become available for the treatment of Crohn's disease, and it is important to evaluate mucosal healing as well as clinical remission from Crohn's disease treatment at the appropriate time [4]. Presently, capsule endoscopy for Crohn's disease is performed in Japan, but there is the risk of retention of the capsule endoscope in cases of severe stenosis, and insertion of the balloon endoscope deeply into the small intestine is difficult in such cases. "
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    ABSTRACT: Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD) precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE) with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE. Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens. Results. According to the CTE findings, patients were determined to be in the active CD group (n = 31) or inactive CD group (n = 8). The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P < 0.0001), whereas mucosal healing was found in 62.5% of inactive group patients but in only 3.2% of active group patients (P < 0.0001). Conclusion. CTE appeared to be a useful diagnostic method for assessment of mucosal healing in Crohn's disease.
    Gastroenterology Research and Practice 04/2013; 2013:984916. DOI:10.1155/2013/984916 · 1.75 Impact Factor
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