Abstract Background Crohn’s disease (CD) is characterized by transmural inflammation and achieving transmural healing (TH) indicated by absence of inflammation on imaging study or endoscopy 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 (definition of both endoscopic healing and radiological healing), endoscopic healing (EH: absence of ulceration on ileocolonoscopy) alone, radiological healing (RH: no sign of active inflammation on imaging study) alone, and no healing (NH: presence of inflammation on both ileocolonoscopy and cross-sectional imaging) were assessed. We used Cox proportional hazards models and modified Poisson regression Results Among 180 included patients 40.5% were males and the mean disease duration was 12.5 years. Of these patients, 26.7% achieved TH, 21.1% EH, 12.8% RH and 39.4% 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 5yrs) and highest in patients with NH (13%, 20.5%, 26.9%). On Cox proportional hazard regression analysis, TH was associated with a significantly reduced risk of CD-related surgery (HR 0.01, 95%CI 0.00–0.35, p = 0.009) compared to NH. The probabilities of surgery were numerically lower for patients with RH compared to EH (10% vs. 13.2%, 10% vs. 18.4% and 21.2% vs. 26.9% at 1, 3 and 5yrs). Probabilities of CD related hospitalization were lowest with TH (4.3%, 8.8% and 13.6% at 1, 3 and 5yrs) Conclusion Transmural healing was associated with superior long-term outcomes compared to endoscopic or radiologic healing alone. Future studies should focus on standardizing its definition and evaluate treat-to-target strategies Conflict of interest: Dr. Vuyyuru, Sudheer: Received consulting fee from Alimentiv Inc Goodwin, Shane: None Solitano, Virginia: Speaker’s fees from Pfizer, Takeda, Giuliani, Tillotts Pharma consulting fees from J & J travel grant from Abbvie Ramsewak, Daryl: None Kassam, Zahra: has received consulting fees from Alimentiv Inc and Bayer Inc. Townsend, Cassandra: has received advisory board fees from Celltrion, Pendopharm and Takeda Gregor, James: received speakers fees from AbbVie, Janssen, Takeda, Celltrion, Organon and Ferring Beaton, Melanie: Melanie Beaton has received advisory board or consultancy from AbbVie, Celltrion, Ferring, Janssen, Novo Nordisk, Pfizer, and Takeda. She has participated in clinical trials with AbbVie, Novo Nordisk, Gilead, Takeda, Janssen, Pfizer and Astra Zeneca Crowley, Eileen: Grant: Research grant from Abbvie & Pfizer Personal Fees: Consulting fees from Alimentiv Inc. & Sanofi (Advisory board) Alkhattabi, Maan: None Sey, Michael: has received consultant fees from Medtronic research grants and speaker fees from Pendopharm educational grant from Cook Medical. Jairath, Vipul: Consulting Fees: Abbvie, Alimentiv, Amgen, Anaptys Bio, Asahi Kasei, Asieris, Astra Zeneca, Attovia, Blackbird Labs, BMS, Boehringer Ingleheim, Biomebank, Caldera, Calluna, Catalytic Health, Celltrion, Ensho, Enthera, Exeliome Biosciences, Ferring, Fresenius Kabi, Gilead, Granite Bio, GSK, Janssen, Lilly, Merck, Mountainfield, MRM Health, Nxera, Organon, OSE Immunotherapeutics, Pendopharm, Pioneering Medicine, Pfizer, Prometheus, Roche/Genentech, Sanofi, SCOPE, Shattuck Labs, Sorriso, Spyre, Synedgen, Takeda, Teva, Tillotts, Union Therapeutics, Ventus, Ventyx, Vividion, Xencor, Zealand Pharma.
Vuyyuru et al. (Thu,) studied this question.