title: Transmural healing evaluated by bowel sonography in patients with Crohn's disease on maintenance treatment with biologics.
abstract: BACKGROUND
  Both thiopurines and anti-tumor necrosis factor (TNF) α agents are effective for treating Crohn's disease (CD) as they can induce clinical remission (CR) and mucosal healing (MH) in most patients. Nevertheless, data on transmural healing (TH) induced by thiopurines and anti-TNF-α agents are still lacking. This study aimed to explore the rate of TH evaluated by bowel sonography in patients with CD treated with biologics and immunosuppressors and its correlation with CR and MH.
  
  
  METHODS
  We performed an observational longitudinal study evaluating TH, CR, and MH in all patients with CD attending our clinic who would complete 2 years of maintenance treatment with biologics or thiopurines. CR and MH were assessed in accordance with current literature, whereas TH was recorded using bowel sonography. All patients underwent endoscopy and bowel sonography before starting treatment and 2 years later.
  
  
  RESULTS
  The study included 66 patients with CD treated with biologics and 67 patients receiving thiopurines. Finally, TH was present in 17 patients on biologics and only 3 patients treated with thiopurines (25% versus 4%; P < 0.01; odds ratio = 6.2). CR was achieved in 37 patients on biologics and in 34 patients on thiopurines (59.7% versus 53%; P = not significant), whereas MH was more frequent in patients treated with anti-TNF-α agents even though without statistical significance (38% versus 25%; P = not significant).
  
  
  CONCLUSIONS
  TH can be achieved in approximately 25% of patients with CD treated with anti-TNF-α agents and significantly correlates with MH. Further studies are needed to define the potential role of TH as long-term prognostic factor.
authors.affiliation: Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Castiglione
authors.forename: Anna
authors.initials: A
authors.lastname: Testa
authors.forename: Matilde
authors.initials: M
authors.lastname: Rea
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: De Palma
authors.forename: Maria
authors.initials: M
authors.lastname: Diaferia
authors.forename: Dario
authors.initials: D
authors.lastname: Musto
authors.forename: Francesca
authors.initials: F
authors.lastname: Sasso
authors.forename: Nicola
authors.initials: N
authors.lastname: Caporaso
authors.forename: Antonio
authors.initials: A
authors.lastname: Rispo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001688:Biological Products / Q000627:therapeutic use*; D003113:Colonoscopy; D003424:Crohn Disease / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007422:Intestines / Q000000981:diagnostic imaging*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000187:drug effects* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D014463:Ultrasonography; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology; D055815:Young Adult
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents