Gastroenterology Department, Hospital da Senhora da Oliveira, Rua Dos Cutileiros, Creixomil, 4835-044, Guimarães, Portugal.
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Dig Dis Sci. 2022 Apr;67(4):1278-1286. doi: 10.1007/s10620-021-07148-2. Epub 2021 Jul 21.
Optimal strategies for using small-bowel capsule endoscopy (SBCE) in established small-bowel Crohn's disease (CD) remain uncertain. Mucosal healing (MH) has emerged as a valuable predictor of a flare-free disease. We aimed to evaluate the occurrence of disease flare on patients with small-bowel CD and MH, as well as to create a score identifying patients in higher risk for this outcome.
We analyzed consecutive patients submitted to SBCE for assessment of MH and included those where MH was confirmed. The incidence of disease flare was assessed during follow-up (minimum 12 months). A score predicting disease flare was created from several analyzed variables.
From 47 patients with MH, 12 (25.5%) had a flare (versus 48.3% in excluded patients without MH; p = 0.01). Age ≤ 30 years (OR = 70; p = 0.048), platelet count ≥ 280 × 10/L (OR = 12.24; p = 0.045) and extra-intestinal manifestations (OR = 11.76; p = 0.033) were associated with increased risk of CD flare during the first year after SBCE with MH. These variables were used to compute a risk-predicting score-the APEX score-which assigned the patients to having low (0-3 points) or high-risk (4-7 points) of disease flare and had excellent accuracy toward predicting disease relapse (AUC = 0.82; 95%CI 0.64-0.99).
Patients with small-bowel CD and MH were not free of disease flares on the subsequent year, despite presenting lower rates when compared to those without MH. The APEX score demonstrated excellent accuracy at stratifying patients relapse risk and guiding further therapeutic options for patients achieving MH.
在已确诊的小肠克罗恩病（CD）中，使用小肠胶囊内镜（SBCE）的最佳策略仍不确定。黏膜愈合（MH）已成为无疾病发作的有价值的预测指标。我们旨在评估小肠 CD 和 MH 患者的疾病发作情况，并创建一种能够识别具有较高该结果风险的患者的评分。
我们分析了连续接受 SBCE 评估 MH 的患者，并纳入了那些 MH 得到证实的患者。在随访期间（至少 12 个月）评估疾病发作的发生率。从多个分析变量中创建了一种预测疾病发作的评分。
在 MH 的 47 例患者中，有 12 例（25.5%）出现疾病发作（而 MH 阴性的排除患者中这一比例为 48.3%；p=0.01）。年龄≤30 岁（OR=70；p=0.048）、血小板计数≥280×10/L（OR=12.24；p=0.045）和肠外表现（OR=11.76；p=0.033）与 SBCE 后 MH 后第一年 CD 发作风险增加相关。这些变量用于计算风险预测评分-APEX 评分-将患者分为低风险（0-3 分）或高风险（4-7 分），并具有预测疾病复发的优异准确性（AUC=0.82；95%CI 0.64-0.99）。
尽管与 MH 阴性患者相比，MH 的小肠 CD 患者在随后的一年中并没有免于疾病发作，但仍存在疾病发作的风险。APEX 评分在分层患者复发风险和指导 MH 患者的进一步治疗选择方面具有优异的准确性。
