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Predictors of bowel damage in the long-term progression of Crohn’s disease

World Journal of Clinical Cases 2022年第33期10卷 12208-12220页

作者： Agnes Fernández-Clotet Julian Panés Elena Ricart Jesús castro-Poceiro Maria carme.Masamunt Sonia Rodríguez Berta Caballol Ingrid Ordás Jordi Rimola Department of Gastroenterology Hospital ClinicBarcelona 08036Spain Universitat de Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS)Barcelona 08036Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHDMadrid 28029Spain Department of Radiology Hospital ClinicBarcelona 08036Spain

BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disorder that progresses to bowel damage(BD)over *** image-based index,the Lémann index(LI),has been developed to measure cumulative *** To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term *** This was a single-center longitudinal cohort *** who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were reevaluated after 5-12 *** Seventy-two patients were *** increased in 38 patients(52.8%),remained unchanged in 9 patients(12.5%),and decreased in 25 patients(34.7%).The small bowel score and surgery subscale significantly increased(P=0.002 and P=0.001,respectively),whereas the fistulizing subscale significantly decreased(P=0.001).Baseline parameters associated with BD progression were ileal location(P=0.026),CD phenotype[stricturing,fistulizing,or both(P=0.007,P=0.006,and P=0.035,respectively)],disease duration>10 years(P=0.019),and baseline LI stricturing score(P=0.049).No correlation was observed between BD progression and baseline clinical activity,biological markers,or severity of endoscopic *** BD,as assessed by the LI,progressed in half of the patients with CD over a period of 5-12 *** main determinants of BD progression were ileal location,stricturing/fistulizing phenotype,and disease duration.

关键词： Crohn’s disease Lémann index Bowel damage Inflammatory bowel disease Magnetic resonance imaging

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Endoscopic response to tumor necrosis factor inhibitors predicts long term benefits in Crohn's disease

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World Journal of Gastroenterology 2019年第14期25卷 1764-1774页

作者： Ignacio Alfaro Maria carme.Masamunt Nuria Planell Alicia López-García Jesús castro Marta Gallego Rebeca Barastegui Angel Giner Alejandro Vara Azucena Salas Elena Ricart Julián Panés Ingrid Ordás Gastroenterology Department Hospital Clínic de Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) University of Barcelona

BACKGROUND Identifying predictors of therapeutic response is the cornerstone of personalized *** To identify predictors of long-term mucosal healing(MH) in patients with Crohn's disease(CD) treated with tumor necrosis factor α(TNF-α) *** Prospective single center study. Consecutive patients with clinically active CD requiring treatment with a TNF-α inhibitor were included. A baseline segmental CD Endoscopic Index of Severity(CDEIS) ≥ 10 in at least one segment or the presence of ulcerations were required for inclusion. Clinical, biological and endoscopic data were obtained at baseline, weeks 14 and 46. Endoscopic response(ER) was defined as a decrease ≥ 50% from baseline CDEIS and MH as partial CDEIS ≤ 5 in all *** Of 62 patients were included. At baseline, median CD Activity Index and CDEIS were 201 and 6.7, respectively with a significant reduction after one year of treatment(53 and 3.0 respectively, P < 0.001). At week 14, 56% of patients achieved ER and 34% MH. At week 46, the corresponding percentages were 52%and 44%. Baseline disease characteristics or biomarkers did not predict MH. A decrease from baseline CDEIS at week 14 of at least 80% was the best predictor of MH at week 46(59% sensitivity and 91% specificity; area under the curve =0.778).CONCLUSION Clinical and biomarker data are not useful predictors of response to TNF-αinhibitors in CD, whereas ER to induction therapy, defined as 80% reduction in global CDEIS, is a robust predictor of long-term MH. Achievement of this endoscopic endpoint may be considered as a therapeutic target for anti-TNF-αtherapy.

关键词： Crohn’s disease Endoscopy Mucosal healing Crohn’s Disease Endoscopic Index of Severity Tumor necrosis factor

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