Transmural healing is not associated with less disability than complete endoscopic mucosal healing: a prospective study in a patient with Crohn's disease

Introduction: Crohn's disease (CD) is associated with disability by affecting physical and emotional well-being, and by altering social interactions. The impact of transmural healing on disability is currently unknown. Methods We conducted a monocentric cross-sectional study. Patients followed for CD in endoscopic remission (CDEIS < 4) underwent within < 4 weeks an intestinal ultrasound (IUS) and a disability assessment by an IBD-disk and were consecutively included. Four groups were considered: (A) transmural healing defined by the combination of complete endoscopic healing (CDEIS = 0) and ultrasound healing (bowel wall thickness (BWT) less than 3 mm), (B) complete endoscopic healing, (C) ultrasound healing and (D) Partial healing. Moderate to severe disability was defined as an overall score ≥ 40. Results A total of 85 patients were included. Forty-four (51.7%) were female, the median age and disease duration were 38 years ([IQR], 33–44) and 12.0 years (IQR, 5–20). The median global IBD-Disk score was 25 (IQR, 9–41) and 24 patients (28.2%) had moderate to severe disability. Transmural healing (group A) was observed in 40 patients (47.1%). Moderate to severe disability was identified in 17.5% (7/40) of patients with transmural healing, 25% (4/16) with endoscopic healing, 44.4% (8/18) with ultrasound healing and 45.4% (5/11) without healing. There was no difference in terms of severe disability between patients with transmural healing and complete endoscopic healing (group B versus A OR = 1.5 95% CI [0.3, 6.2], p = 0.525) Conclusions Transmural healing did not provide any benefit in terms of disability compared to complete endoscopic healing.