Issue 13

Clinical Question

How effective are clinical symptoms and inflammatory biomarkers in confirming mucosal healing in patients with Crohn’s disease (CD) involving the small bowel (SB)?

Editor’s Bottom Line

Despite clinical and inflammatory biomarker remission, over 2/3 of patients still do not have complete mucosal healing.

Editorial Note

This study illustrates the ongoing inflammation that exists in the SB despite our best attempts to normalize clinical symptoms and inflammatory biomarkers. Future studies will have to guide us as to the risk/benefit value of therapeutic optimization in this patient population. At the current time this author does not optimize therapy for patients in clinical and biomarker remission.

Reference

Kopylov U, Yablecovitch D, Lahat A, et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn’s disease using biomarkers, capsule endoscopy, and imaging. Am J Gastroenterol. 2015 Sep;110(9):1316–23. https://www.ncbi.nlm.nih.gov/pubmed/26215531

Synopsis

Eligible patients had small bowel CD in steroid-free remission (CDAI <150) for 3-24 months, and were on stable doses of medications, including immunosuppressants, infliximab, adalimumab, and 5-ASA. N=52 were in clinical remission only with elevated inflammatory biomarkers (fecal calprotectin or C-reactive protein). N=21 were in clinical and inflammatory biomarker remission. Patients underwent video capsule endoscopy and the Lewis score was used to quantify mucosal inflammation and define mucosal healing.¹

Results

Patients with clinical remission only = 15% had mucosal healing.
Patients with clinical and biomarker remission = 33% with mucosal healing

¹LS<135: mucosal healing; LS=135-790: mild-moderate inflammation; and LS >790 is moderate-severe inflammation.

Details

Study Design: Observational, prospective cohort study
Funding: Helmsley Charitable Trust
Allocation: n/a
Setting: Israel
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.