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.
Background Transmural healing has emerged as a new treatment target and can be assessed non-invasively with intestinal ultrasound (IUS). We investigated whether the presence of persistent sonographic changes were associated with clinical complications including medication escalation, corticosteroid use, hospitalisation and surgery in Crohn’s disease (CD) patients in clinical remission at baseline. Methods A retrospective study on 212 patients (50% male) with CD who had IUS between August 2017- June 2020 was performed at a tertiary centre. Our analysis included patients in clinical remission at baseline IUS (HBI≤2 or CDAI<150). Patients were excluded if they had disease confined to the rectum, stoma in situ, suboptimal IUS assessment or < 6 months of follow up available. We compared time of medical escalation, corticosteroid use, IBD related hospitalisation or related surgery in patients with and without sonographic inflammation defined as bowel wall thickness (BWT) >3mm and/or hyperaemia on colour doppler imaging, followed for a median of 19 months. We identified factors associated with survival using Kaplan Meier analysis and Cox proportional hazard model. Results At baseline IUS, 61% of patients had sonographic inflammation. During the follow-up period medical escalation occurred in 51% of patients, corticosteroid use in 23%, hospitalisation in 20% and IBD related surgery in 13% of patients. The presence of sonographic inflammation at baseline was associated with increased risk of medical escalation (p=0.0057), corticosteroid use (p=0.037), hospitalisation (P=0.0085) and surgery (P=0.0062) (Figure 1 A-D). On multivariable analysis only maximal BWT significantly predicted medical escalation (HR 1.22 (1.02–1.46), P=0.0268). The presence of hyperaemia at baseline IUS was significantly associated with corticosteroid use (HR 2.20 (1.13–4.28), P= 0.02). No sonographic parameter predicted the need for IBD related hospitalisation or surgery. Baseline immunomodulator use and stricturing (B3) phenotype was significantly associated with surgery (HR 3.59 (1.22–10.54), P=0.02, HR 4.01 (1.14–14.03), P=0.03, respectively). Figure 1: Kaplan-Meier analysis of the effect of sonographic healing vs sonographic inflammation. A) Medication escalation-free survival. B) Corticosteroid-free survival. C) Hospitalisation-free survival. D) Surgery-free survival. Conclusion In CD patients in clinical remission, persistent sonographic inflammation can be used as a non-invasive marker of increased risk for clinical complications.
Background and AimLong‐term human albumin (HA) infusions improve survival in cirrhotic patients with diuretic resistant ascites. We aimed to determine whether there is a significant benefit in a more unwell real‐world cohort.MethodsThis is a single‐center retrospective cohort study. Patients received outpatient HA between April 2017 and June 2021. Inclusion criteria were age ≥18 years, cirrhosis with ascites, and received at least 1 month of HA. Patients with significant comorbidities and ongoing alcohol use were not excluded. Outcomes assessed were transjugular intrahepatic portosystemic shunt (TIPS)/transplant‐free survival (TTFS), and biochemical and prognostic outcomes.ResultsTwenty‐four patients were included. Median age was 59.5 years. Seven were female (29.2%). Etiology included were alcohol (50%), non‐alcoholic steatohepatitis (16.7%), and viral/alcohol (12.5%). Median model for end‐stage liver disease‐sodium (MELD‐Na) was 18.5, with Child–Pugh scores (CPS) A (4.2%), B (50%), and C (45.8%). Improvements in serum sodium (P = 0.014), albumin (P = 0.003), and CPS (P = 0.017) were observed. Reduction in hospitalizations (P = 0.001), particularly portal hypertensive related admissions was observed (relative risk 0.39; 95% confidence interval [CI] 0.21–0.69, P = 0.003), needed to treat 2.09 (95% CI 1.25–3.67). There was a reduction in total paracentesis requirements (P = 0.005). On multivariate analysis, type 2 diabetes mellitus significantly increased risk of TIPS/transplant/death (hazard ratio 6.16; 95% CI 1.23–30.84, P = 0.027). Median TTFS improved in patients with a change in MELD‐Na ≤1 at 1 month: 29.4 months versus 7.7 months (P = 0.011).ConclusionOutpatient HA infusions decrease portal hypertensive related hospital admissions, improve serum sodium, albumin levels, and CPS. Type 2 diabetes mellitus and change in MELD‐Na score help discriminate those likely to benefit most.
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