Endoscopic remission difficult to achieve in patients with CD with large, deep ulcers
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Achieving endoscopic remission may be difficult for patients with Crohn’s disease with larger and deep ulcers in the ileum or rectum, according to results published in the American Journal of Gastroenterology.
“Overall degree of endoscopic inflammation as measured numerically by endoscopic scores does not affect the likelihood of achieving week 26 [endoscopic remission],” Neeraj Narula, MD, MPH, FRCPC, from the division of gastroenterology, department of medicine and Farncombe Family Digestive Health Research Institute at McMaster University in Ontario, Canada, and colleagues wrote.
Narula and colleagues performed a post hoc analysis of the Study of Biologic and Immunomodulator Naive Patients in Crohn Disease (SONIC) trial to evaluate baseline and week 26 endoscopy indices in 172 patients using the CD Endoscopic Index of Severity and the Simple Endoscopic Score for CD. They also used multivariate logistic regression models adjusted for confounders to evaluate the impact of baseline ulcer depth and size on achieving week 26 endoscopic remission.
Results showed the endoscopic rate of ileal ulcers, vs. endoscopic rates throughout the colon, was significantly lower (P < .0001). Ileal ulcers over 2 cm were less likely to achieve endoscopic remission compared with smaller ulcers (OR = 0.31; 95% CI, 0.11–0.89). Further, rectal ulcers over 2 cm correlated with lower odds for week 26 endoscopic remission (OR = 0.26; 95% CI, 0.08–0.8). However, ulcer size in the other five colonic segments did not impact achievement of week 26 endoscopic remission.
“Deep ileal and rectal ulcers [over] 2 cm compared with smaller or superficial ulcers were even less likely to achieve week 26 ER [ileum: OR = 0.1; 95% CI, 0.02–0.68; rectum: OR = 0.12; 95% CI, 0.02–0.82],” Narula and colleagues wrote. “High baseline Simple Endoscopic Score for CD (16) or CDEIS scores (12) did not affect achieving week 26 ER.”
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Narula N, et al. Am J Gastroenterol. 2020;doi: /10.14309/ajg.0000000000000617.
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