COMPARISON OF ENDOSCOPIC HEALING, HISTOLOGIC HEALING AND INTESTINAL BARRIER HEALING FOR PREDICTING LONG TERM DISEASE BEHAVIOUR IN IBD PATIENTS

Aims Endocopic healing is a key therapeutic goal in the management of inflammatory bowel diseases (IBD) that is associated with favorable disease outcome. Here, we prospectively compared the predictive value of endoscopic healing with histologic and barrier healing for predicting long-term disease behavior in a large cohort of clinical remittent IBD patients

Methods IBD patients in clinical remission were prospectively included. At baseline, ileocolonoscopy with assessment of intestinal barrier function by confocal laser endomicroscopy (CLE) in the ileum and colon was performed. Endoscopic and histologic activity and barrier healing were scored along established scores. During subsequent follow-up (FU), patients were closely monitored for disease activity and the occurrence of major clinical events (MCE), defined as the following: disease flare, IBD-related hospitalization or- surgery, initiation of systemic steroids, immunosuppressants or biologics or escalation of an existing biological therapy.

Results 181 patients (100 CD, 81 UC) were included. During a mean FU of 35 (CD) and 25 (UC) months, 73% of CD and 69% of UC patients experienced MCE. The probability of MCE-free survival was significantly higher in IBD patients with endoscopic remission compared to patients with endoscopically active disease. In addition, histologic remission predicted MCE-free survival in patients with UC but not in CD. Barrier healing on endomicroscopy was highly accurate for predicting the further course of IBD and outcompeted endoscopic and histologic remission for predicting MCE-free survival.

Conclusions Barrier healing is highly predictive of the further course of disease in clinically remittent IBD patients with superior diagnostic performance compared to endoscopic and histologic remission.

Publication History

Article published online:
14 April 2022