One‐year clinical outcomes with biologics in Crohn's disease: transmural healing compared with mucosal or no healing

Abstract

Background: While mucosal healing has been proved to predict relevant clinical outcomes in Crohn's disease (CD), little is known about the long-term significance of transmural healing. Aims:To prospectively assess the 1-year clinical outcomes in CD patients achieving transmural healing following treatment with biologics, and to compare them with those in patients reaching only mucosal healing or no healing.Methods: Observational longitudinal study, evaluating 1-year outcomes in terms of steroid-free clinical remission, rate of hospitalisation and need for surgery in a group of CD patients treated with anti-tumour necrosis factor (TNF) alpha for 2 years.Bowel sonography was used in all patients to determine transmural healing.Results: Of 218 patients who completed a 2-year treatment course with anti-TNF alpha, 68 (31.2%) presented transmural (plus mucosal) healing (bowel wall thickness ≤3 mm at bowel sonography), 60 (27.5%) mucosal healing only, and 90 (41.3%) did not achieve any intestinal healing. Transmural healing was associated with a higher rate of steroid-free clinical remission (95.6%), lower rates of hospitalisation (8.8%) and need for surgery (0%) at 1 year compared to mucosal (75%, 28.3% and 10%, respectively) and no healing (41%, 66.6% and 35.5%, respectively) (P < 0.001). Furthermore, transmural healing was associated with longer intervals until clinical relapse (HR, hazard ratio 0.87, P = 0.01), hospitalisation (HR 0.88, P = 0.002) and surgery (HR 0.94, P = 0.008) than mucosal healing. Also among patients discontinuing treatment with biologics, transmural healing predicted better clinical outcomes at 1 year than mucosal healing (P = 0.01). Conclusions:Transmural healing is an ambitious and powerful treatment goal associated, to a greater extent than mucosal healing, with improvement of all clinical outcomes. Additionally, transmural healing is associated with better long-term clinical outcomes than mucosal healing also after discontinuation of biologics.

Assessment of bioelectrical phase angle as a predictor of nutritional status in patients with Crohn's disease: A cross sectional study

“…Crohn's disease (CD) is a chronic inflammatory disorder involving any part of the gastro-intestinal tract and is characterized by a relapsing course [1]. Patients affected by CD have an increased risk of malnutrition due to malabsorption, diarrhea, multiple intestinal resection, inadequate food intake, enhanced nutrient requirements, anorexia, pain and vomiting [2].…”

Evaluation of nutritional adequacy in adult patients with Crohn’s disease: a cross-sectional study

“…Generally, CD patients are at risk of nutritional deficiencies both during periods of disease exacerbation (due to reduced oral intake, malabsorption, and nutrient losses through the gut) and remission [3][4][5]. Specifically, poor and/or inadequate oral intake may play an important role in the onset of malnutrition due to many factors such as voluntary food restrictions, increased satiety, reduced sensation of pleasure related to eating, changes in mood, and even medical advice [6,7].…”

Association between Health-Related Quality of Life and Nutritional Status in Adult Patients with Crohn’s Disease

“…Inflammatory bowel diseases (IBDs), of which Crohn's disease (CD) is a subtype, are chronic inflammatory conditions of the gastrointestinal tract with unpredictable periods of relapse and remission [1][2][3]. Due to disease symptoms such as abdominal pain, fever, diarrhea, anorexia, and anemia, as well as complications such as surgery, abscesses, fistulas, and stenosis, CD patients are vulnerable to experiencing psychosocial issues because of changes in many aspects of social and work life, which impacts their quality of life (QoL) and wellbeing [4][5][6].…”

“…To the best of our knowledge, studies investigating factors influencing quality of life in CD patients have not yet looked at the impact of both nutritional and functional status on perceived QoL. Therefore, the objectives of the present study were: (1) to assess HRQoL in a cohort of CD patients, taking disease severity, gender differences, and previous surgery into account; and (2) to explore the relationship between HRQoL and nutritional risk.…”