Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn’s Disease

Abstract

Aim: To evaluate if a single and/or combined (clinical, endoscopic and radiological) assessment could predict clinical outcomes in Crohn’s disease (CD). Methods: We prospectively evaluated 57 CD cases who underwent both a colonoscopy and a CT-enterography (CTE). Harvey-Bradshaw Index (HBi), SES-CD (and/or Rutgeerts score) and the radiological disease activity were defined to stratify patients according to clinical, endoscopic and radiological disease activity respectively. Hospitalizations, surgery, therapeutic changes and deaths were evaluated up to 36 months (time 1) for 53 patients. Results: CTE and endoscopy agreed in stratifying disease activity in 47% of cases (k = –0.05; p = 0.694), CTE and HBi in 35% (k = 0.09; p = 0.08), endoscopy and HBi in 39% (k = 0.13; p = 0.03). Taken together, CTE, endoscopy and HBi agreed only in 18% of cases (k = 0.01; p = 0.41). Among the 11 cases with mucosal healing, only 3 (27%) showed transmural healing. Patients with endoscopic activity needed significantly more changes of therapy compared to patients with endoscopic remission (p = 0.02). Patients with higher transmural or clinical activity at baseline required significantly more hospitalizations (p < 0.01). Hospitalization rate decreases with an increase in the number of parameters indicating remissions at baseline (p = 0.04). Conclusions: Clinical, endoscopic and radiological assessments offer complementary information and could predict different mid-term outcomes in CD.

Treat-to-target in Crohn’s disease: Will transmural healing become a therapeutic endpoint?

“…The main characteristics of these studies are detailed in Table 1 [ 13 - 15 , 41 - 44 ]. Three studies were prospective[ 15 , 41 , 44 ] and four were retrospective[ 13 , 14 , 42 , 43 ]. Only one study was performed in children[ 43 ].…”

“…The size of the study population ranged from 26[ 42 ] to 214[ 13 ] patients. Location of CD, defined by Montreal[ 45 ] or Paris[ 46 ] classification was as follows: ileocolon (L3)[ 42 ]; terminal ileum (± caecum) (L1) and ileocolon (L3)[ 13 , 14 , 44 ]; and, all types of location (L1, L2, L3 ± L4)[ 15 , 41 , 43 ]. Patients presented all types of CD behavior (defined by Montreal[ 45 ] or Paris[ 46 ] classification), the most prominent being inflammatory behavior (B1)[ 13 , 14 , 41 - 44 ].…”

Editorial: Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn’s Disease

“…Treatment decisions based upon targeting markers of inflammation can impact endoscopic outcomes [1], and improved endoscopic outcomes correlate with improved clinical outcomes [3]. The ongoing REACT2 study should help to close the link between endoscopically informed treatment decisions and clinical outcomes (ClinicalTrials.gov Identifier NCT01698307; results not yet available), but in more difficult patients, similar to the ones included in the study by Laterza et al [2], we may need to extend our assessments beyond the mucosa and consider the cumulative disease burden using a range of assessment modalities.…”

“…In this edition of Digestive Diseases, Laterza et al [2] have set out to evaluate the implications of simultaneous assessments on patients with CD using 3 indices: clinical scoring, endoscopy and CT enterography (CTE). The authors identify a cohort of 57 patients undergoing baseline assessment using all 3 methods within 1 month, with clinical follow-up to 36 months in all except 4 cases.…”

“…In this retrospective study, by selecting a cohort who were determined by their treating clinicians to need these assessments in a narrow time window, Laterza et al [2] have of course, identified a difficult cohort of patients who may well have more complex disease as well as a higher baseline probability of discordance between assessment modalities. It is notable, for example, that most patients exhibited stricturing disease behaviour.…”