P182. Multiparametric evaluation of Crohn's disease: possible role of intestinal healing beyond mucosal healing
I. Scoleri1, L. Laterza1, L. Larosa2, A. Poscia3, E. Gaetani1, V. Gerardi1, G. Bruno1, A. Amato4, L.M. Minordi2, L. Bonomo2, G. Cammarota1, A. Gasbarrini1, F. Scaldaferri1, 1Gastroenterology Division, Catholic University of the Sacred Hearth, Rome, Italy, 2Radiology Department, Catholic University of the Sacred Hearth, Rome, Italy, 3Institute of Hygiene, Catholic University of the Sacred Hearth, Rome, Italy, 4Institute of Anestesiology, Catholic University of the Sacred Hearth, Rome, Italy
Mucosal healing (MH) is a challenging endpoint in Crohn's Disease (CD) therapy, even if inflammation often involves the whole intestinal wall. A more complete evaluation of disease activity (DA) may offer a basis for a tailored therapy. Our aim is to evaluate if a combined (clinical, endoscopic and radiological) disease assessment could predict the relapse rate, after 12 and 36 months.
We enrolled 57 patients, who underwent a colonoscopy and a CT Enterography (CTE) within 1 month (t 0). Each patient was clinically assessed after 12 months (t 1), a subgroup (n = 20) even after 36 months (t 2). Harvey–Bradshaw Index (HBI), SES-CD and the radiological DA, based on the qualitative evaluation of an expert radiologist, were defined at t 0 and used to stratify patients according to clinical, endoscopic and radiological DA. HBI, hospitalizations, surgery, therapeutical changes (TC), exitus were evaluated at t 1 and t 2. An additional analysis was made on the basis of the agreement between clinical, endoscopic and radiological evaluations.
A complete agreement between clinical, endoscopic and radiological DA was found in 15.79% of patients. Patients with moderate–severe clinical DA (HBI ≥8) at t 0 had an higher rate of TC at t 1 than those with mild–moderate clinical DA (5 ≤ HBI ≤ 7) or remission (HBI ≤4) (p = 0.019), while in patients with endoscopic (SES-CD ≥13) or radiological moderate–severe DA the higher rate of TC was not significant. Patients with moderate–severe clinical DA at t 0 had a higher rate of hospitalization at t 2 (p = 0.0005). Patients with a moderate–severe radiological DA at t 0 had a higher rate of hospitalization at t 1 (p = ns) and t 2 (p = 0.0005). At t 2, the rate of hospitalization was higher when at t 0 all the evaluations agreed in indicating DA (p = 0.0474). Between patients with MH at t 0 (n = 23), only 22% had a radiological remission, while 69% and 9% had a mild–moderate and a moderate–severe DA at CTE; patients with radiological DA seemed to have higher rate of TC, hospitalization and surgery.
Clinical, endoscopic and radiological assessments seem to offer complementary informations in CD. MH without transmural healing could be associated with a poorer prognosis. A multiparametric evaluation of CD might suggest a more aggressive therapy in high risk patients.