Transmural Healing Evaluated by Intestinal Ultrasound in Patients with Crohn’s Disease Treated with Infliximab

Abstract

Background and Aims: Transmural healing (TH) has been recently proposed as a measure of deep remission in Crohn’s disease (CD). This study aimed to explore the rate of TH evaluated by intestinal ultrasound (IUS) in patients with CD treated with infliximab (IFX) and its predictive value for long-time clinical remission. Methods: Sixty-four consecutive active CD patients prescribed IFX were retrospectively recruited and followed for at least 2 years. Patients underwent IUS evaluation including bowel wall thickness, stratification, vascularity and mesenteric fat alteration at baseline and 14 weeks after IFX initiation. TH (normalization of all IUS parameters) was assessed at 14 weeks. Results: Fifteen (23.4%) patients achieved TH at 14 weeks, who were at lower risk of clinical relapse during the maintenance period than patients without TH [relative risk (RR) 0.132, P = 0.020]. The multivariate analysis indicated that TH (RR = 0.076, 95% CI: 0.007 - 0.773, P = 0.029) at 14 weeks were negative independent predictors of clinical relapse for patients who achieved steroid-free CR after the induction period. Patients with serum IFX trough levels >3 ug/ml were more likely to achieve TH at 14 weeks (34.3% vs. 10.7%, P = 0.029). Conclusion: IUS is useful in assessing TH, which predicts long-term clinical remission in patients with CD prescribed infliximab.