Transmural healing as a therapeutic goal in Crohn's disease: a systematic review

Geyl, Sophie; Guillo, Lucas; Laurent, V.; D’Amico, Ferdinando; Danese, Silvio; Peyrin–Biroulet, Laurent

doi:10.1016/s2468-1253(21)00096-0

Cited by 72 publications

(61 citation statements)

References 49 publications

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“… 25 combined with our own expert opinion, a majority of the panel recommend defining TR as BWT ≤3 mm with normal CDS for both small and large bowel. This definition is consistent with the definition previously suggested in the article by Geyl et al 84 and with the recommendation from Goodsall et al . for clinical trials.…”

Section: Resultssupporting

confidence: 91%

“…The most used definition of IUS TR in prospective observational trials is BWT ≤ 3 mm alone or in combination with other IUS parameters [ Table 1 ; Supplementary Tables 2 and 3]. 8 , 84 BWT ≤3 mm alone has a substantial association with endoscopic remission [ER] [defined as the absence of ulcerations, SES-CD <2, κ = 0.63, p = 0.01] 18 , 19 and an almost perfect agreement with TR assessed by MRE [defined as BWT ≤3 mm without signs of hypervascularisation], κ = 0.9, p ≤0.01. 19 As expected, 9 BWT ≤3 mm alone has a fair association with clinical remission [CDAI <150], κ = 0.27, p ≤0.01, and a substantial association with C-reactive protein [CRP], κ = 0.79, p = 0.02.…”

Section: Resultsmentioning

confidence: 99%

“…Cross-sectional imaging, an objective biomarker, currently gains increasing attention and incorporation into clinical trials as a proposed treatment target. 84 IUS is an accurate, reliable, cost-effective, patient-friendly, non-invasive imaging modality performed by clinicians in a point-of-care setting. 2 However, definitions for imaging response and transmural remission/healing and optimal assessment timing currently lack international consensus.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Defining Transabdominal Intestinal Ultrasound Treatment Response and Remission in Inflammatory Bowel Disease: Systematic Review and Expert Consensus Statement

Ilvemark

Hansen

Goodsall

et al. 2021

Journal of Crohn's and Colitis

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Background and aims No consensus exists on defining intestinal ultrasound response, transmural healing, or transmural remission in inflammatory bowel disease, nor clear guidance for optimal timing of assessment during treatment. This systematic review and expert consensus study aimed to define such recommendations, along with key parameters included in response reporting. Methods Electronic databases were searched from inception to July 26, 2021, using pre-defined terms. Studies were eligible if at least two intestinal ultrasound assessments at different time points during treatment were reported, along with an appropriate reference standard. The QUADAS-2 tool was used to examine study-level risk of bias. An international panel of experts (n=18) rated an initial 196 statements (RAND/UCLA process, scale 1-9). Two videoconferences were conducted, resulting in additional ratings of 149 and 13 statements, respectively. Results Out of 5826 records, 31 full-text articles, 16 abstracts, and one research letter were included. 83% (40/48) of included studies showed a low concern of applicability, while 96% (46/48) had a high risk of bias. A consensus was reached on 41 statements, with clear definitions of IUS treatment response, transmural healing, transmural remission, timing of assessment, and general considerations when using intestinal ultrasound in inflammatory bowel disease. Conclusions Response criteria and time-points of response assessment varied between studies complicating direct comparison of parameter changes and their relation to treatment outcomes. To ensure a unified approach in routine care and clinical trials, we provide recommendations and definitions for key parameters for intestinal ultrasound response to incorporate into future prospective studies.

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Section: Resultssupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Defining Transabdominal Intestinal Ultrasound Treatment Response and Remission in Inflammatory Bowel Disease: Systematic Review and Expert Consensus Statement

Ilvemark

Hansen

Goodsall

et al. 2021

Journal of Crohn's and Colitis

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show abstract

“…For radiologic evaluation, a simple definition is more feasible because no validated scoring system is available for CTE, and the MRE scoring system is not recommended in clinical practice ( 44 ). Moreover, there is a critical need for establishing a consensus on the definition of RH ( 45 ). Whether achieving combined EH and RH can significantly improve the disease course of patients with CD should also be elucidated in a targeted study.…”

Section: Discussionmentioning

confidence: 99%

Combined Endoscopic and Radiologic Healing Is Associated With a Better Prognosis Than Endoscopic Healing Only in Patients With Crohn's Disease Receiving Anti-TNF Therapy

Noh

et al. 2022

Clin Transl Gastroenterol

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INTRODUCTION: Although endoscopic healing (EH) is recommended as the therapeutic goal in patients with Crohn's disease (CD), combined EH and radiologic healing (RH) could be a more ideal therapeutic goal considering the transmural nature of CD. We compared the prognosis of patients with CD who achieved EH, RH, both EH and RH (deep healing; DH), or no healing under treatment with anti-tumor necrosis factor (TNF) agents. METHODS: We analyzed 392 patients with CD who received anti-TNF treatment for more than 1 year and evaluated with CT enterography or magnetic resonance enterography together with colonoscopy within 3 months between July 2017 and December 2018. Major outcomes (anti-TNF dose intensification, switch to other biologics, CD-related bowel resection, and hospitalization) were compared according to the EH and RH status. RESULTS: During the follow-up (median 18 months; interquartile range, 15–21), the DH group showed a better rate of major outcome-free survival compared with other groups ( P < 0.001). In multivariable analysis, elevated C-reactive protein (adjusted hazard ratio [aHR], 2.166; 95% confidence interval [CI], 1.508–3.110; P < 0.001), EH-only (aHR, 3.903; 95% CI, 1.635–9.315; P = 0.002), RH-only (aHR, 3.843; 95% CI, 1.545–9.558; P = 0.004), and no healing (aHR, 8.844; 95% CI, 4.268–18.323; P < 0.001) were associated with increased risks of major outcomes. DISCUSSION: Patients with CD who achieved DH under anti-TNF therapy showed a better prognosis compared with those who only achieved EH. The possibility of DH being used as a new therapeutic target for patients with CD should be investigated in further studies.

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“…The utility of intestinal ultrasound (IUS) in the assessment of CD is well established ( 10 , 11 ), while the literature surrounding its use in UC remains questioned. In the context of a “treat-to-target” strategy and close monitoring, IUS plays a crucial role due to its non-invasiveness.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons

et al. 2022

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Intestinal ultrasound (IUS) plays a crucial role as a non-invasive and accurate tool to diagnose and assess inflammatory bowel disease (IBD). The rationale for using IUS in Crohn’s disease (CD), a transmural disease, is widely acknowledged. While the use of IUS in ulcerative colitis (UC), a mucosal disease, is often underestimated, but, recently, it is increasingly expanding. In the context of a treat-to-target approach, the role of IUS is shifting toward a monitoring tool for predicting response to therapy. Hence, adjusting therapeutic strategies based on IUS response could reduce the burden related to endoscopy and speed the decision process with the ultimate goal to alter the natural course of IBD. Assessment of bowel wall thickness (BWT) is the most reliable IUS measure. However, the development of validated and reproducible sonographic scores to measure disease activity and the identification of parameters of therapeutic response remain relevant issues to implement the daily adoption of IUS in clinical practice. Accordingly, this review focuses on the current literature investigating the impact of IUS on CD with emphasis on the concept of transmural healing (TH) and the main related advantages. We further explore new insights on the role of IUS in UC and its clinical implications.

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Transmural healing as a therapeutic goal in Crohn's disease: a systematic review

Cited by 72 publications

References 49 publications

Defining Transabdominal Intestinal Ultrasound Treatment Response and Remission in Inflammatory Bowel Disease: Systematic Review and Expert Consensus Statement

Defining Transabdominal Intestinal Ultrasound Treatment Response and Remission in Inflammatory Bowel Disease: Systematic Review and Expert Consensus Statement

Combined Endoscopic and Radiologic Healing Is Associated With a Better Prognosis Than Endoscopic Healing Only in Patients With Crohn's Disease Receiving Anti-TNF Therapy

The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons

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