P225 Cross-sectional evaluation of transmural healing in patients with Crohn’s disease on maintenance treatment with biologics
A. Testa*1, A. Rispo1, P. Mainenti2, N. Imperatore1, G. D. De Palma1, M. Rea1, F. Maione1, O. M. Nardone1, M. L. Taranto1, F. Castiglione1
1University ‘Federico II’ of Naples, Department of Clinical Medicine and Surgery, Naples, Italy, 2University ‘Federico II’ of Naples, Naples, Italy
Transmural healing (TH) of Crohn’s disease (CD) is a new underexplored and interesting outcome of the concept of deep remission. The aim of this study was to assess the rate of TH evaluated by bowel sonography (BS) and magnetic resonance enterography (MRE) in CD patients treated with biologics, directly comparing the 2 cross-sectional procedures.
We performed a 2-year observational longitudinal prospective study evaluating steroid-free clinical remission (CR), mucosal healing (MH), and TH in all patients with CD who would complete a 2-year period of maintenance treatment with biologics. All patients underwent endoscopy, BS and MRE before starting biologics and 2 years later. Further, the Crohn’s Disease Activity Index (CDAI) score was calculated before treatment and 2 years later.
The study included 40 CD patients, biologics (38% infliximab and 62% adalimumab). TH was evident in 10 patients (25%) at BS and in 9 patients (23%) at MRE (k = 0.84; p < 0.01). No significant differences were noted about TH in relation to the type of biologic used (p = NS). MH was obtained in 14 subjects (35%). A good agreement was observed between MH and TH at BS (k = 0.63; p < 0.001) and TH at MRE (k = 0.64; p < 0.001). CR was achieved in 24 patients (60%). A poor agreement was found between CR and TH, both at BS and MRE (k = 0.27 and 0.29, respectively; p < 0.01).
TH can be reached in about 25% of CD patients treated with biologic with high agreement between BS and MRE on defining this outcome. After considering the advantages of BS (high diagnostic accuracy, low costs, high patient compliance, and high availability) and the limitations or MRE (high costs and low availability), we suggest the use of BS as first cross-sectional procedure in defining TH in patients with CD.