Is transmural healing better than mucosal healing in pediatric Crohn's disease?
Giulia D'Arcangelo1, Silvia Rotulo2, Salvatore Oliva2
1Pediatric Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy.
Insights
Transmural healing (TH) in pediatric Crohn's disease (CD) improves outcomes, reducing hospitalizations and complications compared to no healing. While TH offers benefits over mucosal healing (MH), the additional advantage is limited.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Advanced Imaging in IBD
Background:
- Limited data exist on long-term benefits of transmural healing (TH) in pediatric Crohn's disease (CD).
- Understanding healing depth is crucial for optimizing treatment strategies in pediatric CD.
Purpose of the Study:
- To evaluate and compare clinical outcomes in pediatric CD patients achieving TH versus mucosal healing (MH) or no healing (NH).
Main Methods:
- Retrospective, single-center study of 93 pediatric CD patients.
- Utilized MRE, ileocolonoscopy, and capsule endoscopy for healing assessment (TH, MH, NH).
- Assessed outcomes including hospitalizations, surgeries, treatment escalation, and complications at 6, 12, and 24 months.
Main Results:
- TH and MH groups showed reduced treatment escalation risk versus NH.
- TH group demonstrated significantly lower hospitalization and complication rates compared to NH.
- No significant outcome differences were found between TH and MH groups; surgery risk was similar across all groups.
Conclusions:
- Achieving TH in pediatric CD improves outcomes, though the added benefit over MH alone is minimal.
- Persistent inflammation in pediatric CD is linked to poorer long-term outcomes.
- Deeper healing assessment may refine prognostic understanding in pediatric CD.
Background:
Limited data exist on the long-term benefits of transmural healing (TH) in pediatric Crohn's disease (CD).
Aims:
To evaluate outcomes children with CD achieving TH compared to those with mucosal healing (MH) and no healing (NH).
Methods:
Retrospective, single-center study including children with CD undergoing magnetic resonance enterography (MRE), ileocolonoscopy, and/or capsule endoscopy within a three-month interval. TH was defined as mucosal healing on endoscopy and bowel wall healing on MRE. MH as normal ileocolonoscopy with active findings on MRE. NH included active endoscopic disease irrespective of MRE results. Outcomes assessed at 6, 12 and 24 months included hospitalizations, surgeries, treatment escalation and complications.
Results:
Ninety-three children (12 years, 2-17) were included: 23 TH (25 %), 27 MH (29 %) and 43 NH (46 %). Compared to NH, both TH and MH had lower risk of treatment escalation (p < 0.0001 and p = 0.0002, respectively), but only TH was associated with a lower risk of hospitalization (p = 0.02) and complications (p = 0.007). No significant differences were observed between TH and MH regarding all the outcomes. The risk of surgery was comparable across the three groups.
Conclusion:
Achieving TH improves outcome in children with CD, although the additional benefit over MH alone is limited. The persistence of inflammation is associated with worse outcomes in all patients.
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