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Small Bowel Healing Detected by Endoscopy in Patients With Crohn’s Disease After Treatment With Antibodies Against Tumor Necrosis Factor
- Source :
- Clinical Gastroenterology and Hepatology. 18:1545-1552
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- It is important to objectively assess Crohn's disease (CD) activity in patients treated with antibodies against tumor necrosis factor (anti-TNF). Detection of healing by endoscopy (endoscopic healing) associates with patient outcome, based on evidence from studies of ileocolonoscopy. We assessed endoscopic healing after treatment, based on findings from balloon-assisted enteroscopy (BAE), in patients with CD.We performed a post-hoc analysis of data from a clinical trial from 116 patients with CD (46 with ileal and 70 with ileocolonic type) who received induction and then maintenance therapy with anti-TNF agents from January 2013 through March 2018 at a single center in Japan. We compared findings from BAE before induction therapy and then again during maintenance therapy (median 13 months later). Endoscopic healing was defined as the modified simple endoscopic score for CD below 5. We also collected data on previous treatments, makers of inflammation, and disease type.Before treatment, small bowel ulcerations were present in 114 patients (98%); 42 patients (60%) with ileocolonic disease had colon ulcerations. During maintenance therapy, 41/114 patients (36%) had small bowel endoscopic healing; all the patients with small bowel endoscopic healing also had colonic endoscopic healing. Colonic endoscopic healing was observed in 33/42 patients (79%). The proportion of patients with small bowel endoscopic healing was significantly lower than that of colonic endoscopic healing (P.001). Among all patients, failure to achieve small bowel endoscopic healing was significantly associated with structuring or penetrating disease (P = .014), lack of concomitant treatment with immunomodulators (P = .015), and having received previous treatment with an anti-TNF agents (P = .018).In a post-hoc analysis of patients with CD treated with anti-TNF agents, we found small bowel ulcerations, detected by BAE, to be more difficult to heal than colon ulcerations.
- Subjects :
- Enteroscopy
medicine.medical_specialty
Inflammation
Antibodies, Monoclonal, Humanized
Single Center
Gastroenterology
Crohn Disease
Maintenance therapy
Internal medicine
medicine
Humans
Intestinal Mucosa
Crohn's disease
Hepatology
medicine.diagnostic_test
Tumor Necrosis Factor-alpha
business.industry
Adalimumab
Endoscopy
medicine.disease
Infliximab
digestive system diseases
Clinical trial
Treatment Outcome
Tumor Necrosis Factor Inhibitors
Tumor necrosis factor alpha
medicine.symptom
business
Subjects
Details
- ISSN :
- 15423565
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Clinical Gastroenterology and Hepatology
- Accession number :
- edsair.doi.dedup.....be9f829296be578dc48d6d1549c5ed8d