Lucrezia Laterza1, Anna Chiara Piscaglia1,2, Laura Maria Minordi3, Iolanda Scoleri1, Luigi Larosa3, Andrea Poscia4, Fabio Ingravalle1, Arianna Amato5, Sergio Alfieri6, Alessandro Armuzzi7, Giovanni Cammarota1, Antonio Gasbarrini1, Franco Scaldaferri1. 1. Internal Medicine, Gastroenterology and Liver disease Unit, Gastroenterological Area, Gastroenterological-Endocrinometabolic Sciences Department, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 2. Endoscopy and Gastroenterology Unit, ISS, Borgo Maggiore, San Marino. 3. Imaging Department, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 4. Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy. 5. Institute of Anaesthesiology, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 6. Institute of Surgery, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 7. Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Gastroenterological Area, Gastroenterological-Endocrinometabolic Sciences Department, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
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.
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.