P0792Beyond mucosal healing: multimodal monitoring improves outcomes in Crohn’s disease

Abstract Background Monitoring Crohn’s disease (CD) activity has evolved from purely clinical assessment to a multimodal, objective strategy. Achieving both mucosal and transmural healing has become a core therapeutic target. Yet, in real-life settings, the optimal combination and timing of biomarkers, intestinal ultrasound (IUS), and endoscopy remain uncertain. This study aimed to evaluate the feasibility and clinical impact of an integrated treat-to-target monitoring protocol in patients with ileocolonic CD managed medically or surgically. Methods A prospective real-life study included 72 consecutive patients with CD (mean age 33 ± 9 years; 53% female) followed between 2022–2024 in a tertiary Iinflammatory bowell disease (IBD) unit. Monitoring protocol: • C-Reactive Protein (CRP) and fecal calprotectin (FC) at weeks 6, 12, 24, then quarterly; • IUS at months 3, 6, and 12; • Endoscopy at 6–12 months post-surgery or 12 months under biologics; • Therapeutic Drug Monitoring (TDM) when loss of response occurred; • Patient Reported Outcomes (PRO-2) / quality of life (IBDQ) at each visit. Remission targets: FC 150 µg/g, CRP 5 mg/L, bowel wall thickness ≤ 3 mm, and endoscopic Rutgeerts ≤ i1 or SES-CD ≤ 2. Results At 12 months, biomarker remission was reached in 68% of patients, IUS remission in 61%, and endoscopic remission in 56%. Concordance between FC and IUS was 82% (κ = 0.71). Patients achieving transmural remission (IUS + biomarkers) had a markedly lower relapse rate at 24 months (15% vs 43%, p = 0.004) and required fewer hospitalizations (11% vs 28%, p = 0.03). TDM-guided optimization was performed in 22% of biologic-treated cases and improved sustained remission by 19% at 1 year. Conclusion A multimodal, treat-to-target monitoring strategy combining biomarkers, intestinal ultrasound, and endoscopy is feasible in daily practice and enhances early detection of subclinical inflammation. Integrating non-invasive monitoring tools reduces relapse and hospitalization rates, supporting a structured, personalized follow-up approach in Crohn’s disease management. Conflict of interest: Cristina, Tocia: No conflict of interest Dina, Elena: No conflict of interest Dumitru, Andrei: No conflict of interest Rafti, Raluca: No conflict of interest Popescu, Ioana: No conflict of interest Alexandrescu, Luana: No conflict of interest Dumitru, Eugen: No conflict of interest