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Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn's Disease.
Lucrezia Laterza1, Anna Chiara Piscaglia1,2, Laura Maria Minordi3
1Internal Medicine, Gastroenterology and Liver disease Unit, Gastroenterological Area, Gastroenterological-Endocrinometabolic Sciences Department, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Digestive Diseases (Basel, Switzerland)
|March 8, 2018
Summary
Clinical, endoscopic, and radiological assessments in Crohn's disease (CD) provide complementary data. Combining these evaluations helps predict mid-term patient outcomes, guiding treatment decisions.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
- Medical Imaging in IBD
Background:
- Crohn's disease (CD) management relies on assessing disease activity.
- Predicting clinical outcomes in CD is crucial for effective treatment strategies.
- Current assessment methods include clinical, endoscopic, and radiological evaluations, but their combined predictive value is not fully understood.
Purpose of the Study:
- To determine if single or combined assessments (clinical, endoscopic, radiological) can predict clinical outcomes in Crohn's disease patients.
- To evaluate the agreement between different assessment modalities in stratifying disease activity.
- To identify which assessment parameters correlate with specific clinical outcomes like hospitalizations and therapy changes.
Main Methods:
- Prospective evaluation of 57 Crohn's disease patients undergoing colonoscopy and CT-enterography (CTE).
- Stratification of patients based on clinical (Harvey-Bradshaw Index, HBi), endoscopic (SES-CD/Rutgeerts score), and radiological disease activity.
- Monitoring of clinical outcomes including hospitalizations, surgery, therapeutic changes, and deaths up to 36 months.
Main Results:
- Agreement between CTE and endoscopy in disease activity stratification was 47% (k = -0.05).
- Clinical (HBi) and endoscopic assessments showed moderate agreement (k = 0.13).
- Combined assessment agreement was low (18%). Patients with endoscopic activity or higher baseline transmural/clinical activity required more therapy changes and hospitalizations.
Conclusions:
- Clinical, endoscopic, and radiological assessments provide complementary information in Crohn's disease.
- These distinct assessments can predict different mid-term clinical outcomes.
- A comprehensive approach integrating multiple assessment modalities may offer superior predictive value for Crohn's disease management.