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. 2020 Oct;18(11):2518-2525.e1.
doi: 10.1016/j.cgh.2019.11.056. Epub 2019 Dec 5.

Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn's Disease than Endoscopic Healing

Britt Christensen  1 , Jonathan Erlich  2 , Peter R Gibson  3 , Jerrold R Turner  4 , John Hart  4 , David T Rubin  2
Affiliations

Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn's Disease than Endoscopic Healing

Britt Christensen et al. Clin Gastroenterol Hepatol. 2020 Oct.

Abstract

Background & aims: Deep remission, based on clinical remission and evidence of healing during endoscopic evaluation, are goals of medical treatments for Crohn's disease (CD). We investigated whether histologic healing is associated with outcomes of patients with CD ileitis.

Methods: We performed a retrospective study of 101 patients with CD (52% male) isolated to the terminal ileum who had a colonoscopy between September 2005 and June 2015. Our analysis included patients in clinical remission at colonoscopy who had biopsies collected from colon and ileum. The ileum was evaluated for endoscopic healing (no ulceration) and histologic evidence of healing (no active inflammation, erosions, ulceration, or neutrophil infiltration). We compared times of clinical relapse-free survival, medication escalation, corticosteroid use, or hospitalization secondary to disease activity between patients with and without histological and endoscopic healing, followed for a median 21 months. We identified factors associated with survival using Kaplan Meier analysis and Cox proportional hazard model.

Results: At ileo-colonoscopy, 63% of patients had endoscopic healing and 55% had histologic evidence of healing. The level of agreement between endoscopic and histologic activity was fair (62%, K = 0.2250, P = .0064). Forty-two patients had clinical relapse, 45 had medication escalation, 30 required corticosteroids, and 17 were hospitalized (3 required surgery). On multivariate analysis, only histologic healing was associated with decreased risk of clinical relapse (hazard ratio [HR], 2.05; 95% CI, 1.07-3.94; P = .031), medication escalation (HR, 2.17; 95% CI, 1.2-3.96; P = .011), and corticosteroid use (HR, 2.44; 95% CI, 1.17-5.09; P = .018). No factors were associated with hospitalization.

Conclusions: In patients with ileal CD in clinical remission, histologic healing but not endoscopic healing is associated with decreased risk of clinical relapse, medication escalation, or corticosteroid use.

Keywords: Histology; Histopathology; Inflammatory Bowel Disease; Mucosal Healing; Prognostic Factor.

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Conflict of interest statement

Competing Interests/Disclosures: Dr Christensen reports personal fees from Gilead, Novartis, Janssen, Takeda, Pfizer, and Abbvie, grants from Janssen, grants from Janssen and Ferring Pharmaceuticals; Dr Gibson reports personal fees from Allergan, Janssen, MSD, Pfizer, Anatara, Atmo Biosciences, Immunic Therapeutics, Novozymes, and Takeda, and grants from MSD; Dr Rubin reports personal fees from Abbvie, Abgenomics, Allergan Inc, Boehringer Ingelheim Ltd, Bristol-Myers Squibb, Celgene Corp/Syneos, Check-cap, Dizal Pharmaceuticals GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences, GlaxoSmithKline Group, Janssen Pharmaceuticals, Lilly, Narrow River Mgmt, Pfizer, Prometheus Laboratories, Reistone, Shire, Takeda, Techlab, Inc, and grants from Abbvie, Genentech/Roche, Janssen Pharmaceuticals, Prometheus Laboratories, Shire, Takeda. The remaining authors have nothing to disclose.

Figures

Figure 1:
Figure 1:
Flow chart of patients included in the study
Figure 2:
Figure 2:
Kaplan-Meier analysis of effect of endoscopic and histological activity on (A) Clinical relapse-free survival versus histological healing (B) Clinical relapse-free survival versus endoscopic healing (C) Medication escalation-free survival versus histological healing (D) Medication escalation -free survival versus endoscopic healing
Figure 3:
Figure 3:
Kaplan-Meier analysis of effect of endoscopic and histological activity on (A) Corticosteroid-free survival versus histological healing (B) Corticosteroid-free survival versus endoscopic healing (C) Hospitalization-free survival versus histological healing (D) Hospitalization -free survival versus endoscopic healing
See this image and copyright information in PMC

Comment in

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