Transmural Healing Is Associated with Improved Long-term Outcomes of Patients with Crohnʼs Disease

Fernandes, Samuel; Rodrigues, Rita Vale; Bernardo, Sónia; Cortez-Pinto, João; Rosa, Isadora; Silva, João P da; Gonçalves, Ana; Valente, A; Baldaia, Cilénia; Santos, Paula Moura; Correia, Luís; Venâncio, José; Campos, Paula Peixoto; Pereira, António Dias; Velosa, José

doi:10.1097/mib.0000000000001143

Cited by 150 publications

(144 citation statements)

References 21 publications

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“…Overall, our data are in line with Fernandes et al recent publication showing that complete transmural healing is associated with improved long‐term outcomes in CD. Our data support the notion that specific components of the persistent damage may be linked to long‐term disease outcomes, in both clinical practice and clinical trials, such as the need of hospitalisation or surgical resection.…”

Section: Discussionmentioning

confidence: 99%

“…While mucosal healing as assessed by ileocolonoscopy has been studied in depth, few studies have evaluated the characteristics of transmural healing assessed by means of MRE . Of note, residual mural abnormalities, such as wall thickening, or extramural lesions, like creeping fat, can persist in intestinal segments with endoscopic remission . From the clinical point of view, it is crucial to determine whether these lesions represent established persistent damage (likely irreversible) or an inflammatory component that can heal with appropriate anti‐inflammatory therapy …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Of note, residual mural abnormalities, such as wall thickening, or extramural lesions, like creeping fat, can persist in intestinal segments with endoscopic remission. 9,[12][13][14] From the clinical point of view, it is crucial to determine whether these lesions represent established persistent damage (likely irreversible) or an inflammatory component that can heal with appropriate anti-inflammatory therapy. 11,14 To date, no prospective studies have addressed the prevalence of these persistent MRE abnormalities in patients with sustained mucosal healing, their relationship with pre-treatment findings, or their prognostic implications.…”

Section: Introductionmentioning

confidence: 99%

“…9,[12][13][14] From the clinical point of view, it is crucial to determine whether these lesions represent established persistent damage (likely irreversible) or an inflammatory component that can heal with appropriate anti-inflammatory therapy. 11,14 To date, no prospective studies have addressed the prevalence of these persistent MRE abnormalities in patients with sustained mucosal healing, their relationship with pre-treatment findings, or their prognostic implications. To shed light on these aspects, we systematically assessed MRE examinations obtained at baseline and after 1 year in patients with severe endoscopic lesions that achieved endoscopic remission in response to autologous haematopoietic stem cell transplantation (HSCT) or TNF inhibitors.…”

Section: Introductionmentioning

confidence: 99%

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Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Rimola

Alfaro

Fernández-Clotet

et al. 2018

Aliment Pharmacol Ther

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Summary Background In Crohn's disease, it is essential to distinguish between persistent damage and abnormalities that can heal with anti‐inflammatory therapy. Aim To assess magnetic resonance enterography (MRE) lesions that persist in patients in long‐standing endoscopic remission, analyse their relationship with baseline characteristics, and determine their prognostic implications. Methods We systematically reviewed pre‐ and post‐treatment MRE findings in patients with Crohn's disease and severe inflammation (segmental CDEIS ≥ 7 or ulcers in at least one segment) who achieved endoscopic remission (CDEIS < 2) after 1 year of treatment with TNF‐inhibitors or autologous haematopoietic stem‐cell transplantation. Logistic regression analysis was used to identify predictors of persistent abnormalities. Results Endoscopic remission was achieved in 73 intestinal segments in 28 patients (69% females; 9.95 years disease duration, 67.9% inflammatory phenotype; 39.3% ileal location). Creeping fat and intestinal wall fat deposits were unchanged on pre‐ and post‐treatment MRE despite the endoscopic remission. Luminal strictures persisted in 6 out of the 8 segments with baseline strictures, and wall thickening in 23 out of the 72 of segments with thickening at baseline. Predictors of persistent mural thickening were pre‐treatment wall thickness > 5.9 mm (OR = 4.38, P = 0.027) and refractory disease prior to baseline (OR = 2.35, P = 0.001). Creeping fat was the only predictor for persistence of creeping fat (OR = 36.43, P < 0.001). Persistence of strictures at MRE is associated with earlier recurrence (P = 0.014). Conclusions Persistent MRE abnormalities are frequent in patients with Crohn's disease despite achieving endoscopic remission. Significant wall thickening, intestinal fat deposition, strictures, and creeping fat at baseline MRE are signs of established damage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Rimola

Alfaro

Fernández-Clotet

et al. 2018

Aliment Pharmacol Ther

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“…Beyond mucosal healing, histological remission may be associated with improved outcomes 121 122. Furthermore, small studies have shown that normalisation of bowel wall thickness on MRE, or ‘transmural healing’, may be superior to endoscopic healing alone 123. GIUS holds promise as a useful tool to evaluate transmural healing in IBD longitudinally, although further studies are required to validate the prognostic significance of transmural healing before it can be considered a treatment target.

Future roles of GI ultrasound (GIUS)

Preliminary data suggest elastography can aid in differentiating inflammation from fibrosis in stricturing bowel disease (evidence level 4).

Functional bowel ultrasonography may be helpful in identifying intestinal dysmotility in functional bowel disorders (evidence level 4).

GIUS is conceptually a useful tool for IBD activity assessment in pregnancy, although data are lacking (evidence level 5).

GIUS may be a useful tool to evaluate transmural healing in IBD, the prognostic significance of which requires further validation (evidence level 5).

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Section: How To Position Gius In Ibd Clinical Practice?mentioning

confidence: 99%

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

Bryant¹,

Friedman²,

Wright

et al. 2018

Gut

138

159

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Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.

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Accuracy of point‐of‐care intestinal ultrasound for Crohn's disease

Wright

Wang

Wong

et al. 2020

Australas J Ultrason Med

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Background Point‐of‐care ultrasound (POCUS), performed by a gastroenterologist, provides safe and convenient imaging allowing for immediate clinical decision in Crohn's disease. The minimum training required to gain competency, its accuracy and clinical utility requires evaluation. Methods In this pilot study, Crohn's disease activity and extent were assessed using POCUS (performed by a single gastroenterologist following the completion of 200 supervised scans), magnetic resonance enterography (MRE) and ileo‐colonoscopy. The presence of complications was assessed by POCUS and MRE. Accuracy of POCUS was analysed with respect to MRE and ileo‐colonoscopy. Agreement between modalities was assessed using kappa coefficient. Results Forty‐two patients had a POCUS paired with MRE. Thirty‐eight patients had a POCUS paired with ileo‐colonoscopy. When compared to MRE, POCUS was accurate in the assessment of disease activity (sensitivity 87.5%, specificity 61.1%, ROC 0.74), extent (sensitivity 77.8%, specificity 83.3%, ROC 0.81) and complications (sensitivity 85.7%, specificity 94.3%, ROC 0.90). Agreement between POCUS and MRE was moderate (kappa estimates 0.50, P < 0.001, 0.61, P < 0.001 and 0.76, P < 0.001) for disease activity, extent and complications, respectively. When compared to ileo‐colonoscopy, POCUS was accurate in the assessment of disease activity (sensitivity 72%, specificity 86%, ROC 0.79) and extent (sensitivity 85.7%, specificity 86%, ROC 0.86). For POCUS and ileo‐colonoscopy, kappa estimates were 0.55, P < 0.001 for disease activity and 0.62, P < 0.001 for disease extent. Conclusion POCUS performed by a gastroenterologist after completion of limited training is accurate for assessing Crohn's disease activity, extent and the presence of complications.

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Transmural Healing Is Associated with Improved Long-term Outcomes of Patients with Crohnʼs Disease

Abstract: TH is associated with improved long-term outcomes in Crohn's disease and may be a more suitable target than MH.

Cited by 150 publications

References 21 publications

Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

Accuracy of point‐of‐care intestinal ultrasound for Crohn's disease

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