Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn’s Disease

Paredes, José María Rubio; Moreno, N. Fernández; Latorre, Patricia; Ripollés, Tomás; Martínez, María Jesús; Vizuete, José María Jiménez; Moreno-Osset, E

doi:10.1007/s10620-019-05567-w

Cited by 44 publications

(46 citation statements)

References 39 publications

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“…Nonetheless, the thickness of the intestinal wall decreased in just 42.4% of the subjects, and this showed the lack of correlation between the clinical (the study showed a clinical remission of 87.9%) and the morphologic picture. The transmural healing assessed in ultrasounds was correlated with reduced need for surgery and the intensification of the medical treatment, proving that a normal result of the intestinal ultrasound examination may be translated as a probability of almost 100% of good medium-term therapeutic response [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

et al. 2021

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Crohn’s disease is characterized by persistent or recurrent chronic inflammation that may affect any segment of the gastrointestinal tract. It has an oscillating evolution, with periods of activity alternating with periods of remission. Crohn’s disease has a significant impact on the economic status due to its increasing prevalence, often affecting young people. Suitable management for these patients involves frequent evaluations. Even though colonoscopy is the gold standard for the assessment of severity and mucosal healing, it is an invasive maneuver, not easily accepted by patients, and it does not have good repeatability. Intestinal ultrasound has the advantage of being non-irradiating, non-invasive, well-tolerated, cheap, and easy to repeat. Ultrasound parameters such as bowel wall thickness, intestinal wall architecture, intramural vascularisation, proliferation of mesenteric fatty conjunctive tissue, and intraperitoneal fluid can provide good information regarding the severity of the disease, the differentiation between remission and relapse, and its complications. Some of the latest studies show good correlations between ultrasound parameters and inflammation markers (C-reactive protein, fecal calprotectin) and clinical severity scores of Crohn’s disease. Consequently, the importance of intestinal ultrasound has increased lately, and recent studies support its use to evaluate the severity of inflammation, differentiate between active disease and relapse, monitor therapy response and guide treatment, evaluate prognosis, and diagnose complications.

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Section: Discussionmentioning

confidence: 99%

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

et al. 2021

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“…6,7 In addition, transmural healing on IUS is associated with reduction in corticosteroid usage and need for surgery. 8 Despite this, to date, a standardised IUS Crohn's disease scoring system does not exist. 1 In the current study, a systematic review identified 120 statements on Crohn's disease-specific IUS indices for review, and a panel of 18 (15 gastroenterologists and 3 radiologists) experts who utilise IUS in their practice was assembled.…”

Section: N V I T E D E D I T O R I a Lmentioning

confidence: 99%

“…IUS correlates with clinical activity, CRP levels and endoscopic disease activity 6,7 . In addition, transmural healing on IUS is associated with reduction in corticosteroid usage and need for surgery 8 . Despite this, to date, a standardised IUS Crohn's disease scoring system does not exist 1…”

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confidence: 99%

Editorial: use of intestinal ultrasound in the scoring of Crohn's disease activity in clinical trials—is it ready for prime time yet?

Abushamma

Deepak

2021

Aliment Pharmacol Ther

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“… 15 Preliminary studies have shown that TH is associated with lower rates of drug escalation, CD-related hospitalizations, and surgeries, despite heterogeneous study design and inconsistent TH definitions. 11 , 16 , 17 It is still not known whether TH or MH is the better prognostic indicator of long-term outcomes. Therefore, our study aimed to determine TH’s ability to predict long-term outcomes in the presence of MH and other related factors.…”

Section: Introductionmentioning

confidence: 99%

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Zhuang

et al. 2021

Therap Adv Gastroenterol

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Background: Transmural healing (TH) is being increasingly recognized for reflecting deep remission in Crohn’s disease (CD). The long-term clinical significance of achieving TH is still not fully known. We aimed to evaluate TH as a predictor of long-term positive outcomes using intestinal ultrasonography (US), with comparison with the established endpoint mucosal healing (MH). Methods: CD patients were consecutively recruited from September 2015 to August 2018 at a single tertiary hospital. All patients were evaluated at baseline and followed up at 6 months prospectively with a guideline-based treatment regimen. Achieving TH/MH or not was evaluated by US/colonoscopy at the first follow-up. Long-term outcomes including steroid-free clinical remission (CR), drug escalation, hospitalization, and surgery, were recorded after at least another 12 months. Results: We identified 77 patients with a median age of 30 years (range, 12–73 years). Twenty-five (32%) patients achieved TH, and 31 (40%) patients achieved MH. TH and MH were poorly correlated (Cohen’s κ = 0.387; p < 0.05). Univariate analysis showed that both MH and TH were associated with better long-term outcomes. In multivariate analysis, TH was an independent predictor of steroid-free CR [odds ratio (OR), 52.6; p < 0.001], drug escalation (OR, 0.1; p = 0.002), and hospitalization (OR, 0.05; p = 0.005), while MH was an independent predictor of drug escalation (OR, 0.3; p = 0.05). Smoking habit was the only predictor of surgery (OR, 6.6; p = 0.02). Conclusion: TH is an independent predictor of more favorable long-term outcomes than MH, suggesting that TH could become the potential treatment endpoint in CD. Plain language summary Transmural healing predicts good prognosis in Crohn’s disease The therapeutic endpoints of Crohn’s disease keep evolving. The long-term clinical significance of achieving transmural healing is not fully discovered. Transmural healing is an independent predictor of more favorable long-term outcomes than mucosal healing. Transmural healing could become the potential treatment endpoint in Crohn’s disease.

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Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn’s Disease

Cited by 44 publications

References 39 publications

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

Editorial: use of intestinal ultrasound in the scoring of Crohn's disease activity in clinical trials—is it ready for prime time yet?

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

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