Patients with Crohn’s disease achieving transmural healing experience superior long-term outcomes compared with those with endoscopic or radiologic healing alone

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Abstract
Background: Crohn’s disease (CD) is characterized by transmural inflammation, and achieving transmural healing (TH), may lead to improved long-term outcomes. However, evidence supporting this hypothesis is limited. Methods: Adult patients diagnosed with CD who underwent ileocolonoscopy and cross-sectional imaging within 6 months were included. Long-term outcomes of CD-related surgery and hospitalization in patients with TH, endoscopic healing (EH) alone, radiologic healing (RH) alone, and no healing (NH) were assessed. We used Cox proportional hazards models and modified Poisson regression. Results: Among 180 included patients, 26.7% achieved TH, 21.1% achieved EH, 12.8% achieved RH, and 39.4% were classified as NH. At baseline, 54.4% were on biologics which increased to 81.7% at last follow-up (76-78 months across groups). Cumulative probabilities of surgery were lowest in patients with TH (0%, 2.3%, 7.0% at 1, 3, and 5 years) and highest in patients with NH (13%, 20.5%, and 26.9%, respectively) (P = .03). On Cox proportional hazard regression analysis, TH was associated with a significantly reduced risk of CD-related surgery (hazard ratio, 0.01; 95% confidence interval, 0.00-0.35; P = .009) compared with NH. The probabilities of surgery were lower for patients with RH compared with EH (10% vs 13.2%, 10% vs 18.4%, and 21.2% vs 26.9% at 1, 3, and 5 years) but were not statistically significant (P = .41). Probabilities of CD-related hospitalization were lowest with TH (4.3%, 8.8%, and 13.6% at 1, 3 and 5 years) but were not statistically different than other healing categories (P = .67). Conclusions: TH was associated with superior long-term outcomes compared with EH or RH alone. Future studies should focus on standardizing its definition and evaluate treat-to-target strategies.

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