P204 Small bowel mucosal healing and deep remission in patients with known small bowel Crohn's disease.
U. Kopylov*1, D. Yablecovitch2, A. Lahat2, S. Neuman2, N. Levhar2, E. Klang3, M.M. Amitai3, S. Ben-Horin2, R. Eliakim2
1Sheba Medical Center, Gastroenterology, Tel Hashomer, Israel, 2Chaim Sheba Medical Center, Gastroenterology, Ramat Gan, Israel, 3Sheba Medical Center, Department of Diagnostic Imaging, Tel Hashomer, Israel
Mucosal healing (MH) and deep remission (DR) are associated with improved long- and short-term outcomes in Crohn's disease. The vast majority of the available data pertains to colonic MH ***and DR, while the evidence regarding the prevalence and impact of small bowel mucosal healing (SBMH) is scarce.
The aims of the study were to evaluate the prevalence of active inflammation, SBMH and DR in small bowel Crohn's disease (SBCD) patients in clinical remission (CR) or clinically mild disease using biomarkers, video capsule endoscopy (VCE) and magnetic resonance enterography (MRE).
Patients with known SBCD in CR or with mild symptoms (CDAI<220) for at least 3 months were prospectively recruited and underwent MRE, followed by Agile patency capsule. If patency was ***proven, VCE was performed. The Lewis score (LS) was calculated for each tertile. C-reactive protein (CRP) and fecal calprotectin (FC) were evaluated for their association with clinical activity, MRE and VCE findings. Clinical remission was defined as CDAI < 150. FC >100 µg/g and CRP >5mg/ml were considered abnormal. SBMH was defined as LS< 135; significant SB inflammation was defined as LS >790. Biomarker remission (BR) was defined as a combination of CR (CDAI<150) and normal biomarkers. Deep remission (DR) was defined as a combination of BR and SBMH.
Seventy nine patients were recruited and underwent MRE; 51 with proven patency underwent VCE studies. FC levels were elevated in 47.5% of patients, CRP levels in 29.4% and either biomarker- in 56.5% of the cases. SBMH was observed in 26% of the patients, and MRE did not demonstrate active disease in 23.7% of the patients. In patients with clinica and biomarker remission , SBMH was observed in 47.4% and MRE was normal in 56% of the patients. Deep remission was observed in 22.5% of the patients. The prevalence of deep remission was 50% in patients treated with anti-TNFs, whereas it was 20% in patients treated with thiopurines, 11% in patients not receiving any treatment and 0% in patients treated with 5-aminosalycilates (p=0.045 for treated vs not treated with anti-TNFs). There was a significant correlation between normal FC levels and SBMH (r=0.48, p=0.001). CRP did not significantly correlate with SBMH (r=0.54 p=0.1). The combination of both biomarkers did not improve the diagnostic accuracy.
SB inflammation is detected in the majority of CD patients in CR and BR. DR was achieved in 22.5% of the patients in clinical remission and was more frequent in patients ***treated with anti-TNFs. FC was significantly more accurate in prediction of MH than CRP. Our findings emphasize the true inflammatory burden in quiescent patients with SBCD.
UK and DY- equal contribution ; RE and SBH- equal contibution