Use of double-balloon endoscopy and an endoscopic scoring system to assess endoscopic remission in isolated small bowel Crohn's disease after treatment with infliximab.

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2024-01-19 eCollection Date: 2024-01-01 DOI:10.1177/17562848231224842

Wei Han, Jing Hu, Juan Wu, Peipei Zhang, Qiuyuan Liu, Naizhong Hu, Qiao Mei

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Abstract

Background: It is unclear how clinical and endoscopic factors affect the attainment of endoscopic remission (ER) in patients with small bowel Crohn's disease (SB-CD) who are infliximab-naïve.

Objectives: We aimed to identify the effect of different factors on attaining ER using double-balloon endoscopy (DBE) evaluation.

Design: A single-center retrospective observational study was conducted from 1 January 2018 to 30 November 2022. Among 262 patients who were screened for isolated SB-CD by baseline DBE, 108 patients were assessed for effectiveness during maintenance infliximab therapy by a second DBE evaluation.

Methods: DBE findings before and after infliximab therapy were compared. ER was defined as a simple endoscopic score for CD (SES-CD) below 3, and segmental ER as SES-CD activity of 0. Multivariate regression with calculations of odds ratios (OR) was used to determine the impact of different factors on attaining ER.

Results: In all, 41 patients (38.0%) achieved ER. An elevated C-reactive protein at week 6 was independently associated with a decreased probability of ER [OR: 0.86, 95% confidence interval (CI) = 0.75-0.98, p = 0.03]. Segmental ER of the terminal ileum, rather than the proximal ileum, was associated with a higher rate of ER (60.9% versus 38.2%, p = 0.01). High baseline SES-CD (⩾16) was unrelated to overall ER. For patients with disease in the terminal ileum, those with moderate/severe disease were less likely to attain segmental ER than those with mild disease [adjusted odds ratios (aOR): 0.27, 95% CI: 0.09-0.83, p = 0.02]. A large ulcer in the terminal ileum was associated with a lower rate of segmental ER (aOR: 0.18, 95% CI: 0.06-0.56, p = 0.01).

Conclusion: For infliximab-naïve patients with SB-CD, the overall severity of the endoscopic score was unrelated to attainment of ER. Patients were less likely to attain segmental ER if they had greater endoscopic inflammation or larger ulcers in the terminal ileum.

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使用双气囊内镜和内镜评分系统评估英夫利昔单抗治疗后孤立性小肠克罗恩病的内镜缓解情况。

背景：目前尚不清楚临床和内镜因素如何影响英夫利西单抗无效的小肠克罗恩病（SB-CD）患者获得内镜下缓解（ER）：我们旨在通过双气囊内镜（DBE）评估确定不同因素对获得内镜下缓解的影响：2018年1月1日至2022年11月30日进行了一项单中心回顾性观察研究。在通过基线 DBE 筛选出的 262 例孤立性 SB-CD 患者中，108 例患者在英夫利西单抗维持治疗期间通过第二次 DBE 评估进行疗效评估：方法：比较英夫利西单抗治疗前后的 DBE 结果。方法：比较英夫利西单抗治疗前和治疗后的 DBE 结果，ER 定义为 CD 的简单内镜评分（SES-CD）低于 3，节段性 ER 定义为 SES-CD 活动度为 0：结果：共有 41 名患者（38.0%）达到了 ER。第 6 周时 C 反应蛋白升高与ER概率降低独立相关[OR：0.86，95% 置信区间 (CI) = 0.75-0.98，p = 0.03]。末端回肠而非近端回肠的节段性ER与更高的ER发生率相关（60.9% 对 38.2%，p = 0.01）。高基线 SES-CD（⩾16）与总体 ER 无关。对于回肠末端有疾病的患者，中度/重度患者获得节段性ER的几率低于轻度患者[调整后的几率比（aOR）：0.27，95% CI：0.09-0.83，p = 0.02]。回肠末端大面积溃疡与较低的节段性ER率相关（aOR：0.18，95% CI：0.06-0.56，p = 0.01）：结论：对于英夫利西单抗无效的SB-CD患者，内镜评分的总体严重程度与ER的获得无关。如果患者内镜下炎症较重或回肠末端溃疡较大，则其达到节段性ER的可能性较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.