DOP014 Transmural healing is better than mucosal healing in Crohn's disease

Abstract

Background: Mucosal healing (MH) is currently accepted as the optimal target in Crohn's disease (CD), and is associated with improved long-term outcomes including reduced hospitalizations and surgery. However, even in patients with sustained MH, residual transmural inflammation may persist. The benefits of obtaining complete trans-mural healing (TH) have not been previously assessed. The aim of the study was to evaluate the long-term outcomes of TH in CD. Method(s): This was a multicenter observational study including patients from a prospective database of Inflammatory bowel disease (Grupo de Estudos de Doenca Inflamatoria Intestinal). Patients with CD with a MRI-enterography (MRE) and colonoscopy performed in a 6-month interval were included. MRE was classified as ac-tive/inactive based on abnormal bowel wall thickening, contrast en-hancement, fat creeping, Comb sign, and complications (stricture, abscess or fistula). In non-operated patients, colonoscopy was classified as active/inactive based on the presence of ulceration. In operated patients, colonoscopy was classified as active/inactive if the Rut-geerts score was >=i2. We defined 3 groups: TH (inactive MRE with inactive colonoscopy); MH (active MRE with inactive colonoscopy), No healing (NH) (active colonoscopy). We evaluated several outcomes at 1 year including the need for surgery, hospital admission, therapy escalation (immunomodulator, biologic or escalation of biologic), and a compound outcome including any of the former. Patients with disease restricted to the colon were excluded. Result(s): A total of 214 patients [TH (n=33), MH (n=52), NH (n=129)], 91 (41.7%) previously operated, were included in the study. MRE and colonoscopy showed active inflammation in 162 (74.3%) and 132 patients (60.6%), respectively. At 12 months, patients with TH showed lower rates of hospital admission than patients with MH and NH (6.1% vs 17.3%, p=0.188 (ns) and 24.0%, p=0.014), therapy escalation (15.2% vs 36.5%, p=0.027 and 54.3%, p<0.001), surgery (0% vs 11.5%, p=0.047 and 11.6%, p=0.027), and any outcome (18.2% vs 44.2%, p=0.011 and 63.6%, p<0.001). Patients with TH showed longer times to surgery (p=0.045 and p=0.044 for MH and NH), therapy escalation (p=0.046 and p<0.001 for MH and NH), and to reach any endpoint (p=0.019 and p<0.001 for MH and NH). Increasing age (OR 0.971, 95% CI [0.951-0.992], p=0.006), MH (OR 0.384, 95% CI [0.208-0.707], p=0.002), and TH (OR 0.336, 95% CI [0.171-0.660, p=0.002] were independently associated with a lower likelihood of reaching the compound outcome. Conclusion(s): TH is associated with improved long-term outcomes in patients with CD, including lower risk of hospital admission, therapy escalation and surgery. Our data suggests that TH is a better suitable target than MH in CD.