Gastroenterology
Volume 138, Issue 2 , Pages 463-468, February 2010

Mucosal Healing Predicts Sustained Clinical Remission in Patients With Early-Stage Crohn's Disease

  • Filip Baert

      Affiliations

    • H.–Hartziekenhuis Roeselare–Menen vzw, Roeselare, Belgium
    • Corresponding Author InformationReprint requests Address requests for reprints to: Filip Baert, MD, Department of Gastroenterology, H.-Hartziekenhuis Roeselare-Menen vzw, Wilgenstraat 2, B-8800 Roeselare, Belgium. fax: 00-32-51-23 72 96
  • ,
  • Liesbeth Moortgat

      Affiliations

    • H.–Hartziekenhuis Roeselare–Menen vzw, Roeselare, Belgium
  • ,
  • Gert Van Assche

      Affiliations

    • University Hospital Gasthuisberg, Leuven, Belgium
  • ,
  • Philip Caenepeel

      Affiliations

    • Ziekenhuis Oost–Limburg, Genk, Belgium
  • ,
  • Philippe Vergauwe

      Affiliations

    • Groeninge Ziekenhuis, Kortrijk, Belgium
  • ,
  • Martine De Vos

      Affiliations

    • Ghent University, University Hospital, Belgium
  • ,
  • Pieter Stokkers

      Affiliations

    • Academic Medical Centre, Amsterdam, The Netherlands
  • ,
  • Daniel Hommes

      Affiliations

    • Leiden University Medical Centre, Leiden, The Netherlands
  • ,
  • Paul Rutgeerts

      Affiliations

    • University Hospital Gasthuisberg, Leuven, Belgium
  • ,
  • Severine Vermeire

      Affiliations

    • University Hospital Gasthuisberg, Leuven, Belgium
  • ,
  • Geert D'Haens

      Affiliations

    • Imelda GI Clinical Research Centre, Bonheiden, Belgium
  • ,
  • Belgian Inflammatory Bowel Disease Research Group
  • ,
  • North-Holland Gut Club

Received 16 January 2009; accepted 30 September 2009. published online 09 October 2009.

Background & Aims

Few prospective data are available to support the clinical relevance of mucosal healing in patients with Crohn's disease. This study examined whether complete healing, determined by endoscopy, predicts a better outcome in Crohn's disease.

Methods

One-hundred thirty-three newly diagnosed and treatment-naïve Crohn's disease patients were given either a combination of immunosuppressive therapy (azathioprine) and 3 infusions of infliximab or treatment with conventional corticosteroids. Patients given azathioprine were given repeated doses of infliximab for relapses, patients given corticosteroids were given azathioprine in cases of corticosteroid dependency and infliximab only if azathioprine failed. A representative subset of 49 patients from the initially randomized cohort underwent ileocolonoscopy after 2 years of therapy. Correlation analysis was performed between different clinical parameters including endoscopic activity (Simple Endoscopic Score) and clinical outcome 2 years after this endoscopic examination. Data were available from 46 patients 3 and 4 years after therapy began.

Results

Complete mucosal healing, defined as a simple endoscopic score of 0 after 2 years of therapy, was the only factor that predicted sustained, steroid-free remission 3 and 4 years after therapy was initiated; it was observed in 17 of 24 patients (70.8%) vs 6 of 22 patients with lesions detected by endoscopy (27.3%, Simple Endoscopic Score >0) (P = .036; odds ratio = 4.352; 95% confidence interval, 1.10−17.220). Fifteen of 17 patients with mucosal healing at year 2 maintained in remission without further infliximab infusions during years 3 and 4 (P = .032; odds ratio = 4.883; 95% confidence interval, 1.144−20.844).

Conclusions

Complete mucosal healing in patients with early-stage Crohn's disease is associated with significantly higher steroid-free remission rates 4 years after therapy began.

Abbreviations used in this paper: CD, Crohn's disease, CDAI, Crohn's Disease Activity Index, CIS, combined immunosuppressive treatment, CM, conventional management, SES-CD, Simple Endoscopic Score, TNF, tumor necrosis factor

 

 View this article's video abstract at www.gastrojournal.org

 This article has an accompanying continuing medical education activity on page e10. Learning Objective: Upon completion of reading this article, successful learners will be able to interpret the concept of mucosal healing in Crohn's disease, as well as identify patients that would benefit from an endoscopic evaluation and integrate the endoscopic findings as a prognostic marker in the management of Crohn's disease patients.

 Conflicts of interest This study was sponsored by Centocor B.V. This study is a follow-up of an earlier published investigator initiated trial. Although this study was sponsored by an unrestricted grant from Centocor B.V., the authors are fully responsible for its content and the sponsor did not participate in the design or the analysis of the data.

 These authors disclose the following:

 Dr Baert received a research grant to conduct this trial from Centocor.

 Prof De Vos received research support from Schering Plough and UCB.

 The remaining authors disclose no conflicts.

PII: S0016-5085(09)01751-X

doi:10.1053/j.gastro.2009.09.056

Refers to article:

  • February CME Exam 1 Questions , 21 December 2009

    Gastroenterology February 2010 (Vol. 138, Issue 2, Pages e10-e11)

Gastroenterology
Volume 138, Issue 2 , Pages 463-468, February 2010