Endoscopic assessment and treating to target increase the likelihood of mucosal healing in patients with Crohn's disease.
OBJECTIVE
Mucosal healing has been proposed as a goal for treatment because it is associated with improved clinical outcomes of patients with Crohn's disease (CD). However, little is known about the feasibility or probability of achieving mucosal healing in clinical practice. We evaluated the feasibility of treating patients to achieve mucosal healing based on endoscopic evaluation (treating to target).


METHODS
We reviewed the endoscopic outcomes of 67 patients with CD who had lesions detected by endoscopy. Patients underwent 2 to 4 subsequent endoscopic evaluations at the University of California San Diego and were followed up from 2011 through 2012; data were collected on therapies and patient management. The cumulative incidences of mucosal healing and endoscopic improvement were estimated using the Kaplan-Meier method. Factors independently associated with mucosal healing were identified using a Cox proportional hazards model.


RESULTS
After a median follow-up period of 62 weeks, 34 patients (50.7%) had mucosal healing and 41 patients (61.1%) had endoscopic improvement. The cumulative probabilities of mucosal healing were 12.7% and 45.0% at 24 and 52 weeks of treatment, respectively. Factors associated with mucosal healing were as follows: fewer than 26 weeks between endoscopic procedures (hazard ratio, 2.35; 95% confidence interval, 1.15-4.97; P = .035) and adjustment to medical therapy when mucosal healing was not observed (hazard ratio, 4.28; 95% confidence interval, 1.9-11.5; P = .0003).


CONCLUSIONS
In an endoscopic study of patients with CD, we found that assessment of endoscopic disease activity and adjustments to medical therapy (treat to target) increase the likelihood of mucosal healing.
Division of Gastroenterology, University of California San Diego, La Jolla, California; Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France; Inserm U991 University of Rennes 1, Rennes, France.
Guillaume
G
Bouguen
Division of Gastroenterology, University of California San Diego, La Jolla, California.
Barrett G
BG
Levesque
Division of Gastroenterology, University of California San Diego, La Jolla, California.
Suresh
S
Pola
Division of Gastroenterology, University of California San Diego, La Jolla, California.
Elisabeth
E
Evans
Division of Gastroenterology, University of California San Diego, La Jolla, California. Electronic address: wsandborn@ucsd.edu.
William J
WJ
Sandborn
D000328:Adult; D002140:California; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy*; D013505:Digestive System Surgical Procedures; D016903:Drug Monitoring / Q000379:methods* / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
Inflammatory Bowel Disease; Prognostic Factor; Treat-to-Target; Ulcer Detection