Peraza Jellyana, Kaper Marco Emilio, Bargas Andre, Kim Iris, Agrawal Manasi, Larsen Lone, Jacobsen Henrik Albaek, Jess Tine, Colombel Jean-Frederic, Torres Joana, Ungaro Ryan C, Ananthakrishnan Ashwin N
The Dr. Henry D. Janowitz Division Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Aliment Pharmacol Ther. 2025 Mar;61(6):1011-1018. doi: 10.1111/apt.18492. Epub 2025 Jan 5.
Up to 30% of patients with Crohn's disease (CD) will experience a mild disease course. However, there is no consensus definition for mild CD.
To examine the Simple Endoscopic Score for Crohn's disease (SES-CD) thresholds best associated with low likelihood of long-term disease progression.
We conducted a multicentre retrospective cohort study at three tertiary care centres in United States and Europe. We analysed data from 177 surgery-naïve patients with CD who had endoscopic assessment while not on immunosuppressive therapy. The primary outcome was disease progression (systemic steroids, biologic or immunomodulator therapy initiation; new stricturing or penetrating complications; or CD-related hospitalisation or surgery). Univariable and multivariable Cox proportional hazards modelling identified predictors of the primary outcome at 2 and 5 years following endoscopy.
Disease progression occurred in 23% and 35% of patients at years two and five, respectively. Endoscopic severity at enrolment independently predicted disease progression. Compared to those with an SES-CD of 0, an SES-CD ≥ 7 had a greater risk of progression at 2 years (HR 2.50, 95% CI 1.09-5.72) and 5 years (HR 2.89, 95% CI 1.41-5.91). SES-CD > 7 remained independently predictive of disease progression among the 129 immunosuppression-naïve patients (HR 5.65, 95% CI 1.49-21.52) and after excluding patients with prior penetrating disease (HR 2.32, 95% CI 1.00-5.45).
SES-CD ≥ 7 predicts disease progression in mild CD. A score ≤ 6 may help identify patients less likely to progress and be part of the definition of mild CD.
高达30%的克罗恩病（CD）患者病情呈轻度发展。然而，对于轻度CD尚无共识性定义。
研究克罗恩病简易内镜评分（SES-CD）阈值与长期疾病进展低可能性的最佳关联。
我们在美国和欧洲的三个三级医疗中心开展了一项多中心回顾性队列研究。我们分析了177例未接受过手术治疗的CD患者的数据，这些患者在未接受免疫抑制治疗时接受了内镜评估。主要结局为疾病进展（开始使用全身性激素、生物制剂或免疫调节剂治疗；出现新的狭窄或穿透性并发症；或因CD住院或手术）。单变量和多变量Cox比例风险模型确定了内镜检查后2年和5年主要结局的预测因素。
分别有23%和35%的患者在第2年和第5年出现疾病进展。入组时的内镜严重程度可独立预测疾病进展。与SES-CD为0的患者相比，SES-CD≥7的患者在2年时进展风险更高（风险比[HR] 2.50，95%置信区间[CI] 1.09 - 5.72），在5年时也是如此（HR 2.89，95% CI 1.41 - 5.91）。在129例未接受过免疫抑制治疗的患者中，SES-CD>7仍然是疾病进展的独立预测因素（HR 5.65，95% CI 1.49 - 21.52），在排除既往有穿透性疾病的患者后也是如此（HR 2.32，95% CI 1.00 - 5.45）。
SES-CD≥7可预测轻度CD患者的疾病进展。评分≤6可能有助于识别进展可能性较小的患者，并可作为轻度CD定义的一部分。
