Transmural healing is significantly associated with prevention of clinical relapse in Crohn's disease

This multicenter, retrospective study assessed whether endoscopic, histologic, or radiologic remission best predicts outcomes in ileal Crohn's disease (CD). Seventy-one patients who underwent paired colonoscopy with ileal biopsies and magnetic resonance enterography (MRE) were followed for 18 months. While remission by all modalities was associated with reduced relapse on univariate analysis, multivariable analysis showed that only radiologic remission (transmural healing) independently predicted reduced clinical relapse and longer relapse-free survival. Endoscopic and histologic remission showed non-significant trends. These findings suggest transmural healing provides superior prognostic value and may be a more meaningful treatment target in CD.

Transmural healing has been suggested as a potential measure of evaluating the depth of CD remission in the latest consensus guidelines. We aimed to determine the significance of endoscopic, histologic, and radiologic assessment of ileal CD on longitudinal outcomes.

Patients with ileal CD who underwent MRE and colonoscopy with ileal biopsies within a 6-month period were recruited. Rates of clinical relapse over the subsequent 18 months were calculated using pre-determined criteria. Objective histologic assessment was calculated, whilst blinded central radiologists determined the simplified MaRIA score. Multiple logistic regression was used to perform multi-variate analysis. Log-rank analysis was used to assess the time to clinical relapse and displayed using the Kaplan Meier method.

71 patients were included in the final analysis. The odds of clinical relapse in the subsequent 18 months were far lower for patients in remission, compared with disease activity, for each respective modality. Multivariate analysis determined that the only factor independently associated with avoidance of clinical relapse was radiologic remission (OR 0.12, P < .001). Correspondingly, only baseline radiologic remission (compared with radiologic disease activity) demonstrated significantly longer relapse-free survival (522 days vs 339 days, P = .005).

Baseline disease remission was associated with avoidance of clinical relapse at 18 months, however, upon multivariable analysis only radiologic remission (transmural healing) was independently associated with prevention of clinical relapse. This adds to the current literature supporting the potential utility of targeting transmural healing in the management of CD.