W1133 Mucosal Healing Predicts Sustained Clinical Remission in Early Crohn's Disease

Baert, Filip; Moortgat, Liesbeth; Assche, Gert A. Van; Caenepeel, Philip; Vergauwe, Philippe; Vos, Martine De; Stokkers, Pieter; Hommes, Daniël W.; Vermeire, Séverine; Rutgeerts, Paul; Feagan, Brian G.; D’Haens, Geert

doi:10.1016/s0016-5085(08)62987-x

Cited by 17 publications

(14 citation statements)

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“…Rutgeerts et al [22] , in a sub-study of the ACCENT-I trial, found mucosal healing in 50% of 26 patients receiving scheduled infliximab therapy for 1 year. In view of these data and, as expected, the 'top-down' strategy achieved mucosal healing in 73% patients 2 years after starting therapy; moreover, Baert et al [24] reported that those patients who achieved mucosal healing after 2 years of treatment had a significantly higher probability to remain in clinical remission for the following 2 years.…”

Section: The Importance Of Mucosal Healing In Crohn's Diseasesupporting

confidence: 54%

Top-Down Therapy: Is the Evidence Strong Enough?

Domènech

Mañosa²,

Cabré

2009

Dig Dis

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Crohn’s disease (CD) has usually been managed in an escalation manner, introducing more powerful (and toxic) drugs only once those with a better safety profile had failed. However, the natural history of CD under conventional therapeutic strategies results in high intestinal resection requirements and high rates of clinical relapse and steroid dependence. Indirect data seem to point at an improved efficacy of drugs when they are introduced early after disease diagnosis. The spreading use of immunomodulators and the appearance of biological agents prompted the idea of their early introduction in order to change the natural history of the disease. By now, only thiopurines have been shown to reduce steroid requirements, relapse rates, and even surgical requirements, at least in pediatric CD. However, many other ‘top-down’ treatment strategies have not yet been evaluated. In addition, there is a risk of overtreating those 10–30% of patients that will have a benign course of the disease; that’s the reason why the implementation of top-down strategies remains as a matter of debate.

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Section: The Importance Of Mucosal Healing In Crohn's Diseasesupporting

confidence: 54%

Top-Down Therapy: Is the Evidence Strong Enough?

Domènech

Mañosa²,

Cabré

2009

Dig Dis

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“…Результаты многих исследований демонстрируют корреляцию между заживлением слизистой обо-лочки и лучшими исходами БК: снижением частоты обострений, сокращением потребности в госпита-лизации и хирургическом вмешательстве [95,96,97,98,99,100]. Соответственно, сохранение тяжелых эндоскопических поражений слизистой оболочки толстой кишки являлось независимым прогностиче-ским фактором более агрессивного течения заболе-вания с увеличенной потребностью в колэктомии [101].…”

Section: эндоскопические прогностические признакиunclassified

Prognostic Factors in Crohn’s Disease

Щукина¹

2016

Alʹm. klin. med.

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ВВЕДЕНИЕБолезнь Крона (БК) -многофакторное гетероген-ное заболевание с прогрессирующим течением, ха-рактеризующееся хроническим воспалением желу-дочно-кишечного тракта (ЖКТ) [1]. За десятилетний период наблюдения стриктурирующие или пене-трирующие осложнения развиваются у каждого второго пациента с БК, а частота рецидивирования достигает 90% [2].С появлением терапии, способной приостано-вить прогрессирование БК, оценка прогноза на ран-ней стадии приобретает большое значение для раз-работки плана лечения с учетом степени тяжести заболевания [3,4,5,6,7,8]. В проведенных исследо-ваниях предложено множество определений небла-гоприятного (прогрессирующего) или тяжелого (ин-валидизирующего, осложненного) течения БК, сформулированных на основании особенностей раз-вития болезни в процессе определенного периода наблюдения. При этом оценивалось изменение фе-нотипа БК, то есть переход воспалительной формы заболевания в стриктурирующую или пенетрирую-щую форму с развитием соответствующих этим фор-мам осложнений, которые могут способствовать не-обратимому повреждению ЖКТ. Определялась также потребность в госпитализации, в хирургиче-ском лечении, учитывались отсутствие ответа на те-рапию, непрерывное или часто рецидивирующее течение, наличие тяжелых внекишечных проявле-ний, развитие стероидозависимости или стероидо-резистентности, необходимость раннего назначения стероидов и иммуносупрессоров, низкое качество жизни и др. ГЕНДЕРНЫЕ РАЗЛИЧИЯ И ПРОГНОЗ БОЛЕЗНИ КРОНАВ нескольких источниках литературы содержатся данные, свидетельствующие о наличии связи меж-ду гендерными различиями и исходами БК. N. Gupta и соавт. показали повышенный риск хи-рургических вмешательств у больных БК женского пола в педиатрической практике [9], в то время как в двух других исследованиях фактором риска хи-рургического лечения [10,11] PROGNOSTIC FACTORS IN CROHN'S DISEASE Shchukina O.B.North-Western State Medical University named after I. I. Mechnikov; 41 Kirochnaya ul., Saint-Petersburg, 191015, Russian Federation The paper contains a review of the literature data concerning the demographic, clinical, laboratory, genetic, immunohistochemical, endoscopic, and imaging features with a potential role of prognostic factors for clinical management of patients with Crohn's disease.

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“…MH is a useful predictor of a good clinical outcome in patients with CD [3,5,25,26] . We evaluated the predictive value of mSES-CD with regard to the occurrence of surgery due to the worsening of CD inflammation.…”

Section: Mses-cd and The Risk Of Surgery For CDmentioning

confidence: 99%

Clinical utility of a new endoscopic scoring system for Crohn’s disease

Morise¹,

Ando²,

Watanabe³

et al. 2015

WJG

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AIM:To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn's disease (mSES-CD). METHODS:Seventy-six Crohn's disease (CD) patients who underwent transanal double balloon endoscopy (DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new mSES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE, in addition to the activity of four colorectal segments. To compare the usefulness of mSES-CD with SES-CD, we similarly divided the patients into two groups according to total mSES-CD score (low disease activity group, < 4; high disease activity group, ≥ 4). The clinical value of mSES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint. RESULTS:Median age of the 76 CD patients was 36 years (range, 16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm (range, 3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE, of which 62 (83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients (2.7%) with proximal- [6,7] . The SES-CD scores four variables -ulcer size, extent of ulcerated surface, extent of affected surface, and stenosis -from 0 to 3 in the five segments of the ileum, right colon, transverse colon, left colon, and rectum. Daperno et al [8] reported that the SES-CD is a simple, reproducible, and easily used endoscopic scoring system for CD, and showed a strong correlation with CDEIS (r = 0.920). The recent availability of double balloon endoscopy (DBE) allows evaluation of the activity of small intestinal lesions as well as colorectal lesions by an endoscopic procedure. Although a number of incidents have been reported, serious complications with DBE are rare, particularly with diagnostic DBE [9][10][11] . To date, however, a method of evaluating MH in CD which includes the small intestine has not been established. To date, capsule endoscopy (CE) and magnetic resonance enterography (MRE) have both been shown to be capable of assessing mucosal healing [12][13][14][15][16] . ORIGINAL ARTICLEHowever, a method of evaluating MH which includes small intestinal lesions in patients with CD using DBE has not been established. Here, we assessed the importance of evaluating the endoscopic activity of small intestinal lesions by DBE. We also propose a newly modified Simple Endoscopic Score for Crohn's disease (mSES-CD), which includes assessment of the endoscopic activity of small intestinal lesions, and evaluate its usefulness in predicting the prognosis of CD. MATERIALS AND ...

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W1133 Mucosal Healing Predicts Sustained Clinical Remission in Early Crohn's Disease

Cited by 17 publications

References 0 publications

Top-Down Therapy: Is the Evidence Strong Enough?

Top-Down Therapy: Is the Evidence Strong Enough?

Prognostic Factors in Crohn’s Disease

Clinical utility of a new endoscopic scoring system for Crohn’s disease

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