Abstract
Abstract Background Faecal calprotectin (Fcal) and magnetic resonance imaging (MRI) could be used as non-invasive tools to monitor mucosal and transmural healing, respectively, in Crohn’s disease (CD). We assessed the agreement between Fcal and MRI in detecting active CD and to explore the complementarity of these tools in predicting long-term CD outcomes. Methods Using pooled data from two prospective studies, we included patients with CD who underwent both MRI and Fcal testing within 7 days. MRI was performed without bowel cleansing or enema but with 0.5–1L of PEG for bowel distension. MRI included a segmental assessment of jejunum, non-terminal ileum, terminal ileum (last 30 cm), right colon, transverse colon, left colon/sigmoid colon, and rectum. Transmural healing on MRI was defined as a C-score <0.5 in all segments. Patients were classified into four groups: transmural healing (both normal), MRI healing (Fcal >100 μg/g but normal MRI), biochemical healing (Fcal <100 μg/g but abnormal MRI), and no healing (both Fcal and MRI abnormal). The endpoints were the time to bowel damage progression and the time to relapse-related drug discontinuation. Survival analyses were performed using the log-rank test (univariate) and Cox models (multivariate). Results were expressed as hazard ratios (HR) with 95% confidence intervals. Results Among the 112 patients included, 6.2% (7/112), 11.6% (13/112), 18.8% (21/112), and 63.4% (71/112) achieved transmural healing, MRI healing, biochemical healing, and no healing, respectively. No significant differences were observed between the four groups. At baseline, 42% (47/112) of patients were symptomatic according to PRO-2. The agreement between IUS and Fcal for detecting active CD was low (69.6%, κ coefficient = 0.10±0.09). A total of 57 patients experienced progression of bowel damage during follow-up. Transmural healing, MRI healing (HR = 0.13[0.04-0.43]), or biochemical healing (HR = 0.24 [0.07-0.77]) were associated with a reduced risk of bowel damage progression compared to no healing (p <0.0001), with a non-significant trend favoring transmural healing over MRI or biochemical healing (Figure 1). Of the 94 patients who discontinued treatment due to relapse during follow-up, transmural healing was associated with a lower risk of treatment discontinuation compared to biochemical healing (HR = 0.29[0.02-0.45], p = 0.003), MRI healing (HR = 0.45[0.02-0.60], p = 0.001), or no healing (HR = 0.11[0.018-0.04], p = 0.002). Conclusion Transmural healing, as assessed by two non-invasive tools, MRI and fecal calprotectin, appears to be associated with a reduced risk of bowel damage progression in patients with Crohn’s disease, suggesting an interesting complementarity of these tools in daily clinical practice.
Published Version
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