What question did this study set out to answer?

This research examines whether transmural improvement can serve as an acceptable target for patients with Crohns disease who cannot achieve transmural remission.

April 6, 2026

Transmural improvement may be an acceptable target in patients with Crohns disease

Key Points

This research examines whether transmural improvement can serve as an acceptable target for patients with Crohns disease who cannot achieve transmural remission.
Conducted a retrospective analysis with 411 Crohns disease patients
Utilized endoscopy and MRI enterography for evaluations
Compared rates of surgery, hospitalization, steroid use, treatment changes, and phenotype progression by level of improvement
Transmural improvement significantly lowered surgery rates (0.8% vs 16.3% vs 46.8%)
Reduced hospitalization rates (4.1% vs 30.8% vs 55.4%) observed
Decreased steroid use (8.3% vs 34.6% vs 51.1%) noted
Reduced treatment changes (12.4% vs 51.9% vs 67.2%) found
Phenotype progression reduced (5.9% vs 15.4% vs 31.0%)

Abstract

Abstract Background Transmural remission is associated with improved long-term outcomes in Crohns disease (CD) but is seldom achieved in clinical practice. Less demanding targets may present reasonable alternatives in selected patients. Methods Retrospective analysis including 411 CD patients with 2 evaluations using endoscopy and MRI enterography. Rates of surgery, hospitalization, steroid use, treatment change, and phenotype progression were compared between different degrees of endoscopic and radiologic improvement. Endoscopic remission and improvement were defined as a simplified endoscopic score for CD (SES-CD) ≤3 and as a decrease of ≥50% in the SES-CD, respectively. Radiologic remission and improvement were defined as a simplified Magnetic Resonance Index of Activity (sMaRIA) score ≤1 and as a decrease of ≥1 in the sMaRIA score with a ≤25% decrease in the bowel wall thickness. Regression and propensity score matching with inverse probability weighting (IPW) were used to correct for confounders. Results Although inferior to transmural remission, transmural improvement provided better results than no transmural improvement in respect to surgery (0.8% vs 16.3% vs 46.8%, P .001), hospitalization (4.1% vs 30.8% vs 55.4%, P .001), steroid use (8.3% vs 34.6% vs 51.1%, P ≤ .01), treatment change (12.4% vs 51.9% vs 67.2%, P ≤ .012), and phenotype progression (5.9% vs 15.4% vs 31.0%, P ≤ .035). Multivariate regression demonstrated significant reductions in the risk of surgery (hazard ratio HR, 0.294; CI, 0.174-0.496; P .001), hospitalization (HR, 0.465; CI, 0.310-0.697; P .001), steroid use (HR, 0.628; CI, 0.427-0.923, P = .018), treatment change (HR, 0.705; CI, 0.510-0.972; P = .033), and phenotype progression (odds ratio OR, 3.332; CI, 0.166-0.660; P = .002) with transmural improvement compared to no transmural improvement. The IPW wielded similar results. In patients with transmural improvement, stricturing disease was the most relevant predictor for requiring surgery (HR, 4.043; CI, 1.438-11.369; P = .008) and hospitalization (HR, 3.704; CI, 1.777-7.725; P = .005). Conclusion Transmural improvement may be an acceptable alternative in patients unable to reach transmural remission. However, it may be an insufficient target in patients with stricturing disease.

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