Castiglione Fabiana, Mainenti Pierpaolo, Testa Anna, Imperatore Nicola, De Palma Giovanni Domenico, Maurea Simone, Rea Matilde, Nardone Olga Maria, Sanges Marco, Caporaso Nicola, Rispo Antonio
Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
Radiology, IBB-CNR Naples, Italy.
Dig Liver Dis. 2017 May;49(5):484-489. doi: 10.1016/j.dld.2017.02.014. Epub 2017 Feb 28.
Transmural healing (TH) of Crohn's disease (CD) is a still unexplored and interesting outcome correlated to concept of deep remission.
To assess the rate of TH in CD patients treated with anti-TNF alpha agents using two cross-sectional procedures: bowel sonography (BS) and magnetic resonance enterography (MRE).
We performed a 2-year observational longitudinal study, evaluating steroid-free clinical remission (CR), mucosal healing (MH), and TH in CD patients who would complete a 2-year treatment period with anti-TNFs. All patients underwent endoscopy, BS, and MRE before and after 2 years of treatment.
Forty out of 80 CD patients were treated with anti-TNFs for 2 years. CR was achieved in 24 patients (60%) while MH in 14 (35%). Using BS, TH was observed in 10 patients (25%), while using MRE, TH was observed in 9 patients (23%) (k=0.90; P<0.01). A good agreement was observed between MH and TH, both using BS (k=0.63; P<0.01) and MRE (k=0.64; P<0.01). A poor agreement was found between CR and TH, with both BS and MRE (k=0.27 and 0.29, respectively; P<0.01); even though all patients with TH had achieved CR.
TH can be achieved in about 25% of CD patients treated with anti-TNFs, as shown by BS and MRE. BS could be used as the first cross-sectional procedure to detect TH.
克罗恩病（CD）的透壁愈合（TH）是一种仍未被探索且与深度缓解概念相关的有趣结果。
使用两种横断面检查方法——肠道超声（BS）和磁共振小肠造影（MRE），评估接受抗TNFα药物治疗的CD患者的TH发生率。
我们进行了一项为期2年的观察性纵向研究，评估完成2年抗TNF治疗期的CD患者的无类固醇临床缓解（CR）、黏膜愈合（MH）和TH情况。所有患者在治疗2年前后均接受了内镜检查、BS和MRE。
80例CD患者中有40例接受了2年的抗TNF治疗。24例患者（60%）实现了CR，14例（35%）实现了MH。使用BS观察到10例患者（25%）出现TH，使用MRE观察到9例患者（23%）出现TH（κ = 0.90；P<0.01）。在使用BS（κ = 0.63；P<0.01）和MRE（κ = 0.64；P<0.01）时，MH和TH之间均观察到良好的一致性。在使用BS和MRE时，CR和TH之间的一致性较差（分别为κ = 0.27和0.29；P<0.01）；尽管所有出现TH的患者都实现了CR。
如BS和MRE所示，接受抗TNF治疗的CD患者中约25%可实现TH。BS可作为检测TH的首选横断面检查方法。
