Julie Huet, Kelly Mathieu, Marie Dodel, Dilek Coban, Maëva Bazoge, Bruno Pereira, Anthony Buisson
{"title":"通过粪便钙保护蛋白和肠道超声联合评估克罗恩病患者的经壁愈合与肠道损伤进展风险降低相关","authors":"Julie Huet, Kelly Mathieu, Marie Dodel, Dilek Coban, Maëva Bazoge, Bruno Pereira, Anthony Buisson","doi":"10.1093/ibd/izaf068","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fecal calprotectin (Fcal) and intestinal ultrasonography (IUS) could be used as noninvasive tools to monitor mucosal and transmural healing, respectively, in Crohn's disease (CD). We assessed the agreement between Fcal and IUS to detect active CD and investigated their complementary to predict long-term CD outcomes.</p><p><strong>Methods: </strong>In this prospective study, we consecutively included CD patients with concomitant IUS and Fcal testing within 7 days. Patients were divided into 4 groups: Transmural healing (TH; both normal), IUS healing (Fcal > 100 µg/g but normal IUS), biochemical remission reflecting mucosal healing (MH; Fcal < 100 µg/g but abnormal IUS), and no healing (abnormal Fcal and IUS). The primary endpoint was active CD. The secondary endpoints were time to bowel damage progression, time to relapse-related drug discontinuation, and patients' acceptability (10-points acceptability numerical scale).</p><p><strong>Results: </strong>Among the included 112 patients, 44.6% (50/112), 12.5% (14/112),16.1% (18/112), and 26.8% (30/122) achieved TH, IUS healing, biochemical remission, and no healing, respectively. The agreement between IUS and Fcal to detect an active CD was poor (71.4%, κ-coefficient = 0.41 ± 0.09). Transmural healing was associated with a reduced risk of bowel damage progression compared to no healing (P < .0001) contrary to IUS healing (P = .15) or biochemical remission (P = .84). Transmural healing was associated with a lower risk of relapse-related drug discontinuation than MH (hazard ratio [HR] = 0.09 [0.02-0.45], P = .003), IUS healing (HR = 0.10 [0.02-0.60], P = .001), or no healing (HR = 0.09 [0.018-0.04], P = .002). IUS was better accepted than Fcal testing (9.6 ± 0.8 vs 7.9 ± 2.3; P < .0001, 10-points range-acceptability numerical scale).</p><p><strong>Conclusions: </strong>Transmural healing, evaluated by the combination of noninvasive and well-accepted tools such as Fcal and IUS, is associated with improved long-term outcomes and could be used to monitor patients with CD in daily practice.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Transmural Healing Assessed by Combination of Fecal Calprotectin and Intestinal Ultrasonography Is Associated With Reduced Risk of Bowel Damage Progression in Patients With Crohn's Disease.\",\"authors\":\"Julie Huet, Kelly Mathieu, Marie Dodel, Dilek Coban, Maëva Bazoge, Bruno Pereira, Anthony Buisson\",\"doi\":\"10.1093/ibd/izaf068\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fecal calprotectin (Fcal) and intestinal ultrasonography (IUS) could be used as noninvasive tools to monitor mucosal and transmural healing, respectively, in Crohn's disease (CD). We assessed the agreement between Fcal and IUS to detect active CD and investigated their complementary to predict long-term CD outcomes.</p><p><strong>Methods: </strong>In this prospective study, we consecutively included CD patients with concomitant IUS and Fcal testing within 7 days. Patients were divided into 4 groups: Transmural healing (TH; both normal), IUS healing (Fcal > 100 µg/g but normal IUS), biochemical remission reflecting mucosal healing (MH; Fcal < 100 µg/g but abnormal IUS), and no healing (abnormal Fcal and IUS). The primary endpoint was active CD. The secondary endpoints were time to bowel damage progression, time to relapse-related drug discontinuation, and patients' acceptability (10-points acceptability numerical scale).</p><p><strong>Results: </strong>Among the included 112 patients, 44.6% (50/112), 12.5% (14/112),16.1% (18/112), and 26.8% (30/122) achieved TH, IUS healing, biochemical remission, and no healing, respectively. The agreement between IUS and Fcal to detect an active CD was poor (71.4%, κ-coefficient = 0.41 ± 0.09). Transmural healing was associated with a reduced risk of bowel damage progression compared to no healing (P < .0001) contrary to IUS healing (P = .15) or biochemical remission (P = .84). Transmural healing was associated with a lower risk of relapse-related drug discontinuation than MH (hazard ratio [HR] = 0.09 [0.02-0.45], P = .003), IUS healing (HR = 0.10 [0.02-0.60], P = .001), or no healing (HR = 0.09 [0.018-0.04], P = .002). IUS was better accepted than Fcal testing (9.6 ± 0.8 vs 7.9 ± 2.3; P < .0001, 10-points range-acceptability numerical scale).</p><p><strong>Conclusions: </strong>Transmural healing, evaluated by the combination of noninvasive and well-accepted tools such as Fcal and IUS, is associated with improved long-term outcomes and could be used to monitor patients with CD in daily practice.</p>\",\"PeriodicalId\":13623,\"journal\":{\"name\":\"Inflammatory Bowel Diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-04-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Inflammatory Bowel Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ibd/izaf068\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Inflammatory Bowel Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ibd/izaf068","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Transmural Healing Assessed by Combination of Fecal Calprotectin and Intestinal Ultrasonography Is Associated With Reduced Risk of Bowel Damage Progression in Patients With Crohn's Disease.
Background: Fecal calprotectin (Fcal) and intestinal ultrasonography (IUS) could be used as noninvasive tools to monitor mucosal and transmural healing, respectively, in Crohn's disease (CD). We assessed the agreement between Fcal and IUS to detect active CD and investigated their complementary to predict long-term CD outcomes.
Methods: In this prospective study, we consecutively included CD patients with concomitant IUS and Fcal testing within 7 days. Patients were divided into 4 groups: Transmural healing (TH; both normal), IUS healing (Fcal > 100 µg/g but normal IUS), biochemical remission reflecting mucosal healing (MH; Fcal < 100 µg/g but abnormal IUS), and no healing (abnormal Fcal and IUS). The primary endpoint was active CD. The secondary endpoints were time to bowel damage progression, time to relapse-related drug discontinuation, and patients' acceptability (10-points acceptability numerical scale).
Results: Among the included 112 patients, 44.6% (50/112), 12.5% (14/112),16.1% (18/112), and 26.8% (30/122) achieved TH, IUS healing, biochemical remission, and no healing, respectively. The agreement between IUS and Fcal to detect an active CD was poor (71.4%, κ-coefficient = 0.41 ± 0.09). Transmural healing was associated with a reduced risk of bowel damage progression compared to no healing (P < .0001) contrary to IUS healing (P = .15) or biochemical remission (P = .84). Transmural healing was associated with a lower risk of relapse-related drug discontinuation than MH (hazard ratio [HR] = 0.09 [0.02-0.45], P = .003), IUS healing (HR = 0.10 [0.02-0.60], P = .001), or no healing (HR = 0.09 [0.018-0.04], P = .002). IUS was better accepted than Fcal testing (9.6 ± 0.8 vs 7.9 ± 2.3; P < .0001, 10-points range-acceptability numerical scale).
Conclusions: Transmural healing, evaluated by the combination of noninvasive and well-accepted tools such as Fcal and IUS, is associated with improved long-term outcomes and could be used to monitor patients with CD in daily practice.
期刊介绍：
Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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