Toward transmural healing : Sonographic healing is associated with improved long-term outcomes in patients with Crohn's disease
© 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd..
BACKGROUND AND AIMS: Transmural healing has emerged as a treatment target in Crohn's disease (CD). We investigated whether transmural healing assessed with intestinal ultrasound (IUS) is associated with improved clinical outcomes in patients with CD in clinical remission.
METHODS: Patients with CD in clinical remission at baseline (HBI <4) having IUS between August 2017 and June 2020 with at least 6-months' follow-up were retrospectively studied. Time to medication escalation, corticosteroid use and CD-related hospitalisation or surgery were compared by the presence or absence of sonographic healing, defined as bowel wall thickness ≤3 mm without hyperemia on color Doppler, inflammatory fat, or disrupted bowel wall stratification. Factors associated with survival were analyzed by Kaplan-Meier analysis using Cox proportional-hazard model.
RESULTS: Of 202 consecutive patients (50% male), sonographic inflammation was present in 61%. During median follow-up of 19 (IQR 13-27) months, medication escalation occurred in 52%, corticosteroid use in 23%, hospitalisation in 21%, and CD-related surgery in 13%. Sonographic healing was significantly associated with a reduced risk of medication escalation (p = 0.0018), corticosteroid use (p = 0.0247), hospitalisation (p = 0.0102), and surgery (p = 0.083). On multivariable analysis, sonographic healing was significantly associated with an increased odds of medication escalation-free survival (hazard ratio [HR]:1.94; 95% CI 1.23-3.06; p = 0.004) and corticosteroid-free survival (HR:2.41; 95% CI 1.24-4.67; p = 0.009), but not with hospitalisation or surgery.
CONCLUSION: In patients with CD in clinical remission, sonographic healing is associated with improved clinical outcomes. Further studies are needed to determine whether sonographic healing should be a treatment target.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:56 |
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| Enthalten in: |
Alimentary pharmacology & therapeutics - 56(2022), 1 vom: 15. Juli, Seite 84-94 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Vaughan, Rose [VerfasserIn] |
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| Links: |
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| Themen: |
Crohn’s disease |
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| Anmerkungen: |
Date Completed 14.06.2022 Date Revised 31.07.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/apt.16892 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM338737782 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND AND AIMS: Transmural healing has emerged as a treatment target in Crohn's disease (CD). We investigated whether transmural healing assessed with intestinal ultrasound (IUS) is associated with improved clinical outcomes in patients with CD in clinical remission | ||
| 520 | |a METHODS: Patients with CD in clinical remission at baseline (HBI <4) having IUS between August 2017 and June 2020 with at least 6-months' follow-up were retrospectively studied. Time to medication escalation, corticosteroid use and CD-related hospitalisation or surgery were compared by the presence or absence of sonographic healing, defined as bowel wall thickness ≤3 mm without hyperemia on color Doppler, inflammatory fat, or disrupted bowel wall stratification. Factors associated with survival were analyzed by Kaplan-Meier analysis using Cox proportional-hazard model | ||
| 520 | |a RESULTS: Of 202 consecutive patients (50% male), sonographic inflammation was present in 61%. During median follow-up of 19 (IQR 13-27) months, medication escalation occurred in 52%, corticosteroid use in 23%, hospitalisation in 21%, and CD-related surgery in 13%. Sonographic healing was significantly associated with a reduced risk of medication escalation (p = 0.0018), corticosteroid use (p = 0.0247), hospitalisation (p = 0.0102), and surgery (p = 0.083). On multivariable analysis, sonographic healing was significantly associated with an increased odds of medication escalation-free survival (hazard ratio [HR]:1.94; 95% CI 1.23-3.06; p = 0.004) and corticosteroid-free survival (HR:2.41; 95% CI 1.24-4.67; p = 0.009), but not with hospitalisation or surgery | ||
| 520 | |a CONCLUSION: In patients with CD in clinical remission, sonographic healing is associated with improved clinical outcomes. Further studies are needed to determine whether sonographic healing should be a treatment target | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Crohn’s disease | |
| 650 | 4 | |a intestinal ultrasound | |
| 650 | 4 | |a prognostic factor | |
| 650 | 4 | |a transmural healing | |
| 700 | 1 | |a Tjandra, Douglas |e verfasserin |4 aut | |
| 700 | 1 | |a Patwardhan, Ashwin |e verfasserin |4 aut | |
| 700 | 1 | |a Mingos, Nicholas |e verfasserin |4 aut | |
| 700 | 1 | |a Gibson, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Boussioutas, Alex |e verfasserin |4 aut | |
| 700 | 1 | |a Ardalan, Zaid |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Ani, Aysha |e verfasserin |4 aut | |
| 700 | 1 | |a Gibson, Peter R |e verfasserin |4 aut | |
| 700 | 1 | |a Christensen, Britt |e verfasserin |4 aut | |
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