P313. Mucosal healing in Crohn's disease: Prognostic significance and relationship to treatment
P. Sousa1, S. Silva2, M. Cravo1, P. Moura Santos1, L. Tavares1, A.R. Gonçalves1, A. Valente1, L. Correia1, J. Velosa1
1Hospital de Santa Maria, Gastrenterology, Lisboa, Portugal; 2Hospital Central do Funchal, Internal Medicine, Funchal, Portugal
Background: The aim of this study was to evaluate (1) the association between therapy of Crohn's disease (CD) and mucosa healing (MH) (2) the prognostic value of MH in respect to need for corticosteroids/hospitalization and/or surgery (3) the predictive value of C‑reactive protein (CRP) in respect to MH.
Methods: We reviewed the charts of 240 patients with CD. 90 patients were included, 39 men and 51 women, mean age 38 years (19–77). The inclusion criteria were: L2/L3 phenotype, a colonoscopy before changing therapy and a second colonoscopy performed at least one year after this modification. According to Froslie et al, the endoscopic evaluation of the activity was classified as grade 0 (= normal), 1 (= edema/hyperemia) or 2 (= ulcers). Statistical analysis was performed using the software SPSS v. IBM 19.
Results: Mean follow-up period was 39 mo (12–244). 16/90 patients received mesalamine (5ASA) only, 37 azathioprine (AZT) and 37 biologics, 10 of whom in combination with AZT. 11/90 (12%) required surgery during the study period; 5 were on 5ASA, 4 on AZT and 2 on biologics (p = 0.06). The first colonoscopy was performed 5 mo (1–19 mo) before change of therapy and the second colonoscopy 20 mo (12–70) after. We found that patients with ulcers at the first colonoscopy had a greater need of future surgery (p = 0.18), hospital admission (p = 0.26) and corticosteroids (p = 0.16) whereas endoscopic findings after therapy had no prognostic value. After change of therapy there was a significant endoscopic improvement in 48/90 (54%) of patients (p = 0.04). Endoscopic improvement was observed in 16/37 (43%) of patients on AZT, in 17/25 (68%) of those receiving biologics (IFX or ADA) and in 66% (21/32) of patients treated with biological therapy with or without concomitant AZT (p = 0.04). CRP values showed a significant association with endoscopic findings (absence of ulcers) after therapy change (p = 0.008) and with endoscopic improvement (p = 0.03).
Conclusions: (1) The presence of ulcers in the 1st colonoscopy is associated with a higher probability of surgery, hospitalization or corticosteroid therapy (2) Biological therapy (with or without AZT) is associated with a higher rate of endoscopic improvement as compared to AZT alone (3) CRP values may be a reliable indicator of mucosa status.