Cross-sectional evaluation of transmural healing in patients with Crohn’s disease on maintenance treatment with anti-TNF alpha agents

Castiglione, Fabiana; Mainenti, Pier Paolo; Testa, Anna; Imperatore, Nicola; Palma, Giovanni Domenico De; Maurea, Simone; Rea, Matilde; Nardone, Olga Maria; Sanges, M.; Caporaso, Nicola; Rispo, Antonio

doi:10.1016/j.dld.2017.02.014

Cited by 94 publications

(90 citation statements)

References 26 publications

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“…We previously demonstrated that transmural healing is a difficult outcome achievable in about 25% of CD patients treated with anti‐TNF alpha . However, mucosal healing has been proved to be a good endpoint, although inferior respect to transmural healing, but superior to no healing, as clearly demonstrated in previous studies and in the current one.…”

Section: Discussionsupporting

confidence: 82%

“…In CD, however, inflammation is transmural and its involvement can occur anywhere along the GI tract; consequently, evaluation of the mucosal layer alone may fail to accurately reflect disease burden and prognosis. For this reason, Transmural Healing – healing of the entire thickness of the intestinal wall of all inflamed segments involved – has been proposed as a new treatment aim in CD. Recent studies have demonstrated that transmural healing could be a robust but puzzling endpoint that can be achieved in about a quarter of CD patients treated with anti‐TNF alpha agents …”

Section: Discussionmentioning

confidence: 99%

“…Consequently, assessment of the mucosal layer alone may not effectively reflect disease burden and prognosis. For this reason, transmural Healing – which is defined as the normalisation of bowel wall thickness (BWT) of all inflamed segments involved in CD – has been recently proposed as a new endpoint for CD treatment. Recent studies have demonstrated that transmural healing could be a promising treatment goal achievable in about a quarter of CD patients treated with anti‐tumour necrosis factor (TNF) alpha (infliximab and adalimumab) …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Castiglione

Imperatore

Testa

et al. 2019

Aliment Pharmacol Ther

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118

127

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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.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Castiglione

Imperatore

Testa

et al. 2019

Aliment Pharmacol Ther

Self Cite

118

127

View full text Add to dashboard Cite

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“…Crohn's disease (CD) is an idiopathic chronic inflammatory disease able to affect any segment of the gastrointestinal tract, eliciting persistent transmural inflammation with consequent structural bowel damage and intestinal complications such as strictures, fistulae, and abscesses, which often require surgery [1,2]. 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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Purpose Inadequate oral intake may play an important role in the onset of malnutrition in patients with Crohn's disease (CD). The aims of this cross-sectional study were: (1) to compare dietary intake in clinically active and quiescent CD patients, and (2) to assess patients' nutritional adequacy relative to the dietary reference values (DRVs) for the Italian population using LARN (Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana). Methods Patients aged between 18 and 65 years with a diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record. Disease activity was clinically defined using the Crohn's disease activity index (CDAI). Results Overall, 117 patients, 71 males and 46 females, with a mean age of 39.6 ± 13.8 years and a mean body weight of 65.4 ± 11.8 kg, were ultimately included. Our findings showed that the amount of nutrients was similar between patients with active and quiescent disease. The mean intake of macronutrients was adequate, except for fiber, while dietary micronutrients were insufficient. Median intakes of sodium, phosphorus, and fluorine met LARN recommendations in both sexes, and the DRVs were accomplished by many patients (53/117; 104/117 and 98/117, respectively). Interestingly, dietary amounts of iron and zinc were barely acceptable in males but not in females. However, a few of the patients (< 15) met the LARN for potassium, calcium, and magnesium, regardless of sex and CDAI. With respect to vitamins, no relevant difference was found between the active and quiescent groups, and none of them met recommended values in both sexes. Conclusions This study showed that the assessment of dietary intake can be crucial for optimizing dietary intervention with focused nutrition counseling, to improve nutritional status in CD patients.

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“…We read with interest the original article by Castiglione et al and the letter regarding this article by Lopes et al [1,2]. Castiglione et al aimed to assess the rate of transmural healing (TH) by using two cross-sectional procedures; bowel sonography (BS) and magnetic resonance enterography (MRE) in patients with Crohn's disease (CD) who received anti-TNF alpha agents.…”

Section: Cross-sectional Evaluation Of Transmural Healing In Crohn's mentioning

confidence: 99%

Cross-sectional evaluation of transmural healing in Crohn’s disease: Mural and mesenteric parameters

Yüksel

Kılınçalp

2018

Digestive and Liver Disease

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Cross-sectional evaluation of transmural healing in patients with Crohn’s disease on maintenance treatment with anti-TNF alpha agents

Cited by 94 publications

References 26 publications

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

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

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

Cross-sectional evaluation of transmural healing in Crohn’s disease: Mural and mesenteric parameters

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