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Journal of Gastroenterology

, Volume 54, Issue 4, pp 312–320 | Cite as

Bowel wall healing assessed using magnetic resonance imaging predicts sustained clinical remission and decreased risk of surgery in Crohn’s disease

  • Anthony BuissonEmail author
  • Constance Hordonneau
  • Felix Goutorbe
  • Christophe Allimant
  • Marion Goutte
  • Maud Reymond
  • Bruno Pereira
  • Gilles Bommelaer
Original Article—Alimentary Tract
  • 159 Downloads

Abstract

Background

Endoscopic mucosal healing is considered as the best therapeutic target in Crohn’s disease (CD) as it is associated with better long-term outcomes. We investigated whether bowel wall healing (BWH) assessed using magnetic resonance imaging (MRI) could predict favorable outcomes and could be a potential therapeutic target.

Methods

We performed a post hoc analysis from two prospective studies (n = 174 patients). All the patients with previous objective signs of bowel inflammation and assessed by MRI for therapeutic efficacy had a standardized and blinded evaluation, and underwent MRI. Complete BWH was defined as no segmental MaRIA > 7 or no segmental Clermont score > 8.4 and BWH as no segmental MaRIA > 11 or no segmental Clermont score > 12.5. Clinical corticosteroid-free remission (CFREM) was defined as no reappearance or worsening of clinical manifestation leading to therapeutic modification, hospitalization or CD-related surgery. Multivariate analyses were performed including all the relevant parameters.

Results

Overall, 63 patients with CD were included (mean follow-up = 4.8 ± 3.1 semesters). In multivariate analysis (n = 303 semesters), complete BWH or BWH was associated with sustained CFREM according to MaRIA [OR = 4.42 (2.29–26.54); p = 0.042 and OR = 3.43 (1.02–27.02); p = 0.047, respectively] or Clermont score [OR = 3.09 (1.01–12.91); p = 0.049 and OR = 3.88 (1.40–13.80); p = 0.036, respectively]. In multivariate analysis (n = 63 patients), complete BWH or BWH was associated with decreased risk of surgery using MaRIA [HR = 0.16 (0.043–0.63); p = 0.008 and HR = 0.24 (0.07–0.77); p = 0.017, respectively] or Clermont score [HR = 0.24 (0.07–0.78); p = 0.016 and HR = 0.23 (0.07–0.76); p = 0.016, respectively].

Conclusions

MRI endpoints are predictive of favorable outcomes after medical therapy and could be used as therapeutic target in daily practice and clinical trials.

Keywords

Crohn’s disease MRI Therapeutic target Clermont score MaRIA 

Notes

Author contributions

Guarantor of the article: AB. Specific author contributions: AB: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; and study supervision. CH: study concept and design; acquisition of radiologic data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. FG: acquisition of data; critical revision of the manuscript for important intellectual content. CA: acquisition of data; critical revision of the manuscript for important intellectual content. MG: study concept and design; acquisition of data; critical revision of the manuscript for important intellectual content; administrative, technical, and material support. MR: acquisition of data; critical revision of the manuscript for important intellectual content. BP: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; statistical analysis. GB: study concept and design; acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. All authors approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

535_2018_1505_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 30 kb)

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro EntérologieClermont-FerrandFrance
  2. 2.Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018Clermont-FerrandFrance
  3. 3.Université Clermont Auvergne, CHU Clermont-Ferrand, Service de RadiologieClermont-FerrandFrance
  4. 4.Centre Hospitalier de la Côte Basque, Service d’Hépato-Gastro EntérologieBayonneFrance
  5. 5.Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de BiostatistiquesClermont-FerrandFrance

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