Computed tomography enterography-defined transmural healing is associated with lower hospitalization risk in patients...

Transmural healing (TH) has emerged as a potential therapeutic target in Crohn's disease because transmural inflammation may persist despite clinical or endoscopic remission. However, evidence linking TH assessed by computed tomography enterography (CTE) to long-term outcomes remains limited. This study evaluated the association between TH assessed by low-dose CTE and long-term clinical outcomes.

We performed a post hoc analysis of a previously reported retrospective cohort of patients with Crohn's disease who underwent low-dose CTE. Patients in clinical remission (Crohn's Disease Activity Index < 150) at the time of CTE and with ≥ 2 years of follow-up were included. TH was defined according to predefined imaging criteria. The primary outcome was maintenance of clinical remission. Secondary outcomes included hospitalization, bowel obstruction, corticosteroid initiation or escalation, and bowel surgery. Time-to-event outcomes were analyzed using Kaplan-Meier methods and Cox proportional hazards models.

Fifty-two patients were included, and 10 (19.2%) achieved TH. Prior bowel surgery was more common in the TH group (80.0% vs. 40.5%; P=0.040). During a mean follow-up of 83.1 months, Kaplan-Meier analyses showed significantly higher remission maintenance and lower hospitalization rates in the TH group (P=0.007 and P=0.013, respectively). In multivariable Cox analyses, TH remained independently associated with lower hospitalization risk (hazard ratio, 0.084; 95% confidence interval, 0.010-0.728; P=0.025), but not with clinical relapse.

CTE-defined TH was independently associated with lower hospitalization risk, but not with maintenance of clinical remission, in patients with Crohn's disease; however, this association may have been influenced by prior bowel surgery.