Barry Hall1, Grainne Holleran2, Jun-Liong Chin3, Sinead Smith4, Barbara Ryan5, Nasir Mahmud6, Deirdre McNamara7. 1. Department of Gastroenterology, Adelaide and Meath Hospital, Dublin 24, Ireland. Electronic address: bhall@tcd.ie. 2. Department of Gastroenterology, Adelaide and Meath Hospital, Dublin 24, Ireland. Electronic address: hollerag@tcd.ie. 3. Department of Gastroenterology, St James's Hospital, Dublin 24, Ireland. Electronic address: junliong@hotmail.com. 4. Department of Gastroenterology, Adelaide and Meath Hospital, Dublin 24, Ireland. Electronic address: smithsi@tcd.ie. 5. Department of Gastroenterology, Adelaide and Meath Hospital, Dublin 24, Ireland. Electronic address: barbara.ryan2@amcnh.ie. 6. Department of Gastroenterology, St James's Hospital, Dublin 24, Ireland. Electronic address: nmahmud@tcd.ie. 7. Department of Gastroenterology, Adelaide and Meath Hospital, Dublin 24, Ireland. Electronic address: mcnamad@tcd.ie.
Abstract
BACKGROUND: Mucosal healing is increasingly recognised as an important treatment goal in Crohn's disease (CD). Data from colonic disease shows improved long-term outcomes in patients achieving complete mucosal healing. Little is currently known of this with regard to ileitis which is increasingly diagnosed using capsule endoscopy (SBCE). This is the first study to prospectively assess mucosal healing and deep remission rates following 52 weeks of therapy in a cohort of symptomatic small bowel CD patients commencing immunomodulator or biologic therapy. METHODS: Baseline demographics, quality of life questionnaires and Harvey Bradshaw Index were collected along with C-reactive protein & calprotectin. Capsule endoscopy Crohn's disease activity (CECDAI) index was used to assess ileitis severity. All parameters were reassessed at week 52. Results at baseline & week 52 were compared using univariate analysis, p < 0.05 considered significant. RESULTS: In total, 108 capsule procedures were performed on 43 patients. Based on the CECDAI, 39 (90%) demonstrated active small bowel CD at baseline with 28 (65%) undergoing 52 week assessment. In total, 12 (42%) participants achieved complete mucosal healing and deep remission by 52 week assessment (p<0.0001 95% CI -0.62 to -0.22). Despite overall impressive mucosal healing rates, patients with strictures were less likely to demonstrate a decrease in CECDAI and were more likely to have symptoms. CONCLUSION: In patients with active small bowel CD symptomatic and biochemical response to treatment appears to be mirrored by endoscopic remission in 42% of individuals. Strictures identified prior to therapy appear to be a poor indicator for success of treatment.
BACKGROUND: Mucosal healing is increasingly recognised as an important treatment goal in Crohn's disease (CD). Data from colonic disease shows improved long-term outcomes in patients achieving complete mucosal healing. Little is currently known of this with regard to ileitis which is increasingly diagnosed using capsule endoscopy (SBCE). This is the first study to prospectively assess mucosal healing and deep remission rates following 52 weeks of therapy in a cohort of symptomatic small bowel CDpatients commencing immunomodulator or biologic therapy. METHODS: Baseline demographics, quality of life questionnaires and Harvey Bradshaw Index were collected along with C-reactive protein & calprotectin. Capsule endoscopy Crohn's disease activity (CECDAI) index was used to assess ileitis severity. All parameters were reassessed at week 52. Results at baseline & week 52 were compared using univariate analysis, p < 0.05 considered significant. RESULTS: In total, 108 capsule procedures were performed on 43 patients. Based on the CECDAI, 39 (90%) demonstrated active small bowel CD at baseline with 28 (65%) undergoing 52 week assessment. In total, 12 (42%) participants achieved complete mucosal healing and deep remission by 52 week assessment (p<0.0001 95% CI -0.62 to -0.22). Despite overall impressive mucosal healing rates, patients with strictures were less likely to demonstrate a decrease in CECDAI and were more likely to have symptoms. CONCLUSION: In patients with active small bowel CD symptomatic and biochemical response to treatment appears to be mirrored by endoscopic remission in 42% of individuals. Strictures identified prior to therapy appear to be a poor indicator for success of treatment.
Authors: Ioannis V Mitselos; Dimitrios K Christodoulou; Konstantinos H Katsanos; Epameinondas V Tsianos Journal: World J Gastrointest Endosc Date: 2015-06-10
Authors: Parakkal Deepak; Joel G Fletcher; Jeff L Fidler; John M Barlow; Shannon P Sheedy; Amy B Kolbe; William S Harmsen; Terry Therneau; Stephanie L Hansel; Brenda D Becker; Edward V Loftus; David H Bruining Journal: Inflamm Bowel Dis Date: 2018-07-12 Impact factor: 5.325
Authors: Marisol Luján-Sanchis; Laura Sanchis-Artero; Laura Larrey-Ruiz; Laura Peño-Muñoz; Paola Núñez-Martínez; Génesis Castillo-López; Lara González-González; Carlos Boix Clemente; Cecilia Albert Antequera; Ana Durá-Ayet; Javier Sempere-Garcia-Argüelles Journal: World J Gastrointest Endosc Date: 2016-09-16