2015
DOI: 10.1111/apt.13475
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Systematic review with meta‐analysis: mucosal healing is associated with improved long‐term outcomes in Crohn's disease

Abstract: Summary Background Clinical manifestations of Crohn's disease (CD) do not reliably correlate with endoscopic activity. While treating to achieve clinical remission (CR) has neither proven to improve CD outcomes nor alter the natural disease course, it is unclear whether targeting objective measures like mucosal healing (MH) is associated with improved long‐term outcomes. Aim To perform a systematic review and meta‐analysis comparing long‐term outcomes in active CD patients who achieve MH compared to those who … Show more

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Cited by 300 publications
(203 citation statements)
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“…5 However, it is vital to explore surrogate biomarkers (fecal and blood) of biologic remission as repeat endoscopy is a costly endeavor for CD patients. While we did not measure MH at the beginning of our study with endoscopy, we have previously found that the neutrophil CD64 index correlates significantly with the endoscopic severity score for CD (Spearman r = 0.66, p<.001) and have demonstrated that neutrophil CD64 measured during the course of therapy can be utilized to assess for disease progression.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…5 However, it is vital to explore surrogate biomarkers (fecal and blood) of biologic remission as repeat endoscopy is a costly endeavor for CD patients. While we did not measure MH at the beginning of our study with endoscopy, we have previously found that the neutrophil CD64 index correlates significantly with the endoscopic severity score for CD (Spearman r = 0.66, p<.001) and have demonstrated that neutrophil CD64 measured during the course of therapy can be utilized to assess for disease progression.…”
Section: Discussionmentioning
confidence: 99%
“…4 MH, the absence of intestinal ulcerations viewed by endoscopy, has been associated with reduced incidence of CD related complications. 5 Monitoring for MH by endoscopy, however, requires sedation, is costly and is associated with a small risk of complications. In contrast, multiple studies have shown that patient reported symptom indices are unreliable surrogates of MH as both the pediatric CD activity index (PCDAI) and short pediatric CD activity index (shPCDAI) poorly correlate with endoscopic scores of intestinal injury.…”
Section: Introductionmentioning
confidence: 99%
“…According to different studies, young age at diagnosis, demand for steroids during the first flare and the presence of an ileocolonic or perianal disease are risk factors for a severe or complicated disease course [8, 71, 72]. Moreover, the failure of reaching mucosal healing is also a negative predictor [8, 73]. To decide if the individual patient could profit from a more aggressive “top-down” strategy, these risk factors have to be taken into account [74].…”
Section: Individualized Therapy – the Agony Of Choicementioning
confidence: 99%
“…A Blood and Marrow Transplant Clinical Trials Network acute GvHD treatment study provided additional evidence for the 28-day mark as an ideal evaluation point because clinical response to therapy at day 28 best correlated with non-relapse mortality and overall survival [40]. In contrast, there is increasing evidence in adults with chronic IBD that long-term clinical outcomes are not improved by treating to symptom remission, but are improved by directly targeting mucosal inflammation [41,42]. However, the time to development and resolution of target tissue injury (endoscopic changes) can be variable depending on the disease and therapy, and there is poorly defined consensus regarding degree of tissue healing needed for optimizing outcomes or ideal time for endoscopic evaluation post-treatment.…”
Section: Grading and Assessment Of Response To Therapy In Acute Gvhdmentioning
confidence: 99%