title: Cross-sectional evaluation of transmural healing in patients with Crohn's disease on maintenance treatment with anti-TNF alpha agents.
abstract: BACKGROUND
  Transmural healing (TH) of Crohn's disease (CD) is a still unexplored and interesting outcome correlated to concept of deep remission.
  
  
  OBJECTIVE
  To assess the rate of TH in CD patients treated with anti-TNF alpha agents using two cross-sectional procedures: bowel sonography (BS) and magnetic resonance enterography (MRE).
  
  
  METHODS
  We performed a 2-year observational longitudinal study, evaluating steroid-free clinical remission (CR), mucosal healing (MH), and TH in CD patients who would complete a 2-year treatment period with anti-TNFs. All patients underwent endoscopy, BS, and MRE before and after 2 years of treatment.
  
  
  RESULTS
  Forty out of 80 CD patients were treated with anti-TNFs for 2 years. CR was achieved in 24 patients (60%) while MH in 14 (35%). Using BS, TH was observed in 10 patients (25%), while using MRE, TH was observed in 9 patients (23%) (k=0.90; P<0.01). A good agreement was observed between MH and TH, both using BS (k=0.63; P<0.01) and MRE (k=0.64; P<0.01). A poor agreement was found between CR and TH, with both BS and MRE (k=0.27 and 0.29, respectively; P<0.01); even though all patients with TH had achieved CR.
  
  
  CONCLUSIONS
  TH can be achieved in about 25% of CD patients treated with anti-TNFs, as shown by BS and MRE. BS could be used as the first cross-sectional procedure to detect TH.
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy. Electronic address: fabcasti@unina.it.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Castiglione
authors.affiliation: Radiology, IBB-CNR Naples, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Mainenti
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Testa
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Imperatore
authors.affiliation: Surgical Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Radiology, Department of Advanced Biomedical Sciences, University "Federico I", Napoli, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Maurea
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Rea
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Olga Maria
authors.initials: OM
authors.lastname: Nardone
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sanges
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Caporaso
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rispo
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology*; D007558:Italy; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000187:drug effects* / Q000473:pathology; D012074:Remission Induction; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014463:Ultrasonography; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: Crohn’s disease; Magnetic resonance; Transmural healing; Ultrasonography