title: Endoscopic Severity Predicts Long-Term Prognosis in Crohn's Disease Patients with Clinical Remission.
abstract: BACKGROUND
  Mucosal healing has emerged as a desirable treatment goal in clinical practice for patients with Crohn's disease (CD). The aim of this study was to assess the relationship between endoscopic activity and the long-term prognosis of CD using simple endoscopic score for Crohn's disease (SESCD) and Rutgeerts' score.
  
  
  METHODS
  We conducted a cohort study in clinical practice at a single center. Among CD patients who underwent colonoscopy between July 2008 and June 2011 at our hospital, 131 patients with clinical remission were selected, and the patients were divided into 2 groups: a non-surgical group (n = 84) and a surgical group (n = 47). The primary endpoint of this study was to assess the associations between variables and clinical relapse after endoscopic procedures. The cut-off levels of SESCD or Rutgeerts' score for the prediction of relapse were also assessed in patients with clinical remission.
  
  
  RESULTS
  In the non-surgical group, SESCD and C-reactive protein at baseline were significantly higher in patients who had clinical recurrence than in patients who maintained remission. A factor of SESCD ≤2 was independently associated with sustained remission, even in patients with clinical remission. In the surgical group, patients with Rutgeerts' scores ≤1 had significantly prolonged clinical remission compared to patients with Rutgeerts' scores ≥3.
  
  
  CONCLUSIONS
  A cut-off value of SESCD ≤2 and a Rutgeerts' score ≤1 enabled the prediction of long-term prognosis. These cut-off values could be used in clinical trials of endoscopic remission from the point of view of the clinical outcomes of CD.
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Matsuoka
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kiyohara
authors.forename: Mari
authors.initials: M
authors.lastname: Arai
authors.forename: Shinya
authors.initials: S
authors.lastname: Sugimoto
authors.forename: Kiyoto
authors.initials: K
authors.lastname: Mori
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nanki
authors.forename: Keiko
authors.initials: K
authors.lastname: Ohno
authors.forename: Makoto
authors.initials: M
authors.lastname: Mutaguchi
authors.forename: Shinta
authors.initials: S
authors.lastname: Mizuno
authors.forename: Rieko
authors.initials: R
authors.lastname: Bessho
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakazato
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosoe
authors.forename: Nagamu
authors.initials: N
authors.lastname: Inoue
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015331:Cohort Studies; D003113:Colonoscopy; D003424:Crohn Disease / Q000473:pathology / Q000628:therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents; D019804:Mesalamine; D000069285:Infliximab; D000068879:Adalimumab