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. 2019 Mar;10(3):e00015.
doi: 10.14309/ctg.0000000000000015.

Mucosal Healing Is Associated With the Reduced Disabling Disease in Crohn's Disease

Shanshan Huang  1 , Li Li  1 , Shomron Ben-Horin  1   2 , Ren Mao  1 , Sinan Lin  1 , Yun Qiu  1 , Rui Feng  1 , Yao He  1 , Baili Chen  1 , Zhirong Zeng  1 , Minhu Chen  1 , Shenghong Zhang  1
Affiliations

Mucosal Healing Is Associated With the Reduced Disabling Disease in Crohn's Disease

Shanshan Huang et al. Clin Transl Gastroenterol. 2019 Mar.

Abstract

Objectives: Mucosal healing (MH) is the goal of the "treat to target" strategy in Crohn's disease (CD), which seeks to prevent disability. However, evidence is limited regarding whether achieving MH can reduce disability in CD. We aimed to estimate the probability of disabling disease and to investigate the association between MH and disabling disease in CD.

Methods: This was a retrospective case-control study of 319 consecutive CD patients. The primary outcome was disabling disease occurrence (defined as surgery, hospitalizations, steroid dependency, or disease complications). The secondary endpoint was disabling disease recurrence. The Kaplan-Meier method and Cox proportional hazards model were used to calculate cumulative rates and for multivariate analysis, respectively.

Results: Of 319 CD patients (median follow-up time: 42.4 months, interquartile range: 24.7-60.0 months), 105 (32.9%) progressed to disabling disease and 20 (6.3%) had the recurrence of disabling disease. The cumulative rates of disabling disease were 11.3%, 30.2%, and 44.9% at 1, 3, and 5 years, respectively, after diagnosis. MH was associated with a significantly lower frequency of surgery, new penetrating event, and new stenosis (P = 0.004, P = 0.001, P = 0.002, respectively). Univariate and multivariate analyses revealed that MH was an independent protective factor of disabling disease occurrence (hazard ratio: 0.166, 95% confidence interval: 0.084-0.329).

Conclusions: Disabling disease was common in Chinese CD patients and increased during follow-up. Moreover, MH was significantly associated with a reduced occurrence of disabling disease in CD.

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Figures

Figure 1.
Figure 1.
The accumulative rates of remaining free from the occurrence and recurrence of disabling disease in Crohn's disease. (a) The occurrence of disabling disease in Crohn's disease patients. (b) The recurrence of disabling disease in Crohn's disease patients with disabling disease occurrence.
Figure 2.
Figure 2.
Kaplan-Meier analysis showing time to disabling events according to mucosal healing (MH) before disabling disease occurrence. Disabling events: surgery (a), new penetrating event (b), new stenosis (c), and new perianal event (d).
Figure 3.
Figure 3.
Kaplan-Meier analysis showing time to disabling disease occurrence according to different factors. Factors: disease behavior (a), surgery within 6 months at diagnosis (b), futile treatment (c), and mucosal healing (MH) (d).
Figure 4.
Figure 4.
Kaplan-Meier analysis of disabling disease recurrence according to mucosal healing (MH) before disabling disease occurrence in disabling Crohn's disease patients.
See this image and copyright information in PMC

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