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Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era

BACKGROUND AND AIM: While the advent of biologic therapy has led to improved outcomes in perianal fistulizing Crohn's disease (pfCD), loss of response is common. Previous studies suggest that patients who achieve radiological healing (with healing of underlying tracts on magnetic resonance imag...

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Autores principales: Lee, Tanya, Kamm, Michael A, Bell, Sally, Lust, Mark, Brown, Steve, Niewiadomski, Ola, Basnayake, Chamara, Wright, Emily, D'Souza, Basil, Woods, Rodney, Wei, Shu Chen, Connell, William, Thompson, Alexander, Yong, Eric, Ding, Nik Sheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Publishing Asia Pty Ltd 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857282/
https://www.ncbi.nlm.nih.gov/pubmed/33553661
http://dx.doi.org/10.1002/jgh3.12475
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author Lee, Tanya
Kamm, Michael A
Bell, Sally
Lust, Mark
Brown, Steve
Niewiadomski, Ola
Basnayake, Chamara
Wright, Emily
D'Souza, Basil
Woods, Rodney
Wei, Shu Chen
Connell, William
Thompson, Alexander
Yong, Eric
Ding, Nik Sheng
author_facet Lee, Tanya
Kamm, Michael A
Bell, Sally
Lust, Mark
Brown, Steve
Niewiadomski, Ola
Basnayake, Chamara
Wright, Emily
D'Souza, Basil
Woods, Rodney
Wei, Shu Chen
Connell, William
Thompson, Alexander
Yong, Eric
Ding, Nik Sheng
author_sort Lee, Tanya
collection PubMed
description BACKGROUND AND AIM: While the advent of biologic therapy has led to improved outcomes in perianal fistulizing Crohn's disease (pfCD), loss of response is common. Previous studies suggest that patients who achieve radiological healing (with healing of underlying tracts on magnetic resonance imaging [MRI]) have a longer duration of response. The aim of this study was to characterize MRI outcomes of pfCD at a specialist inflammatory bowel disease (IBD) unit and compare the long‐term clinical outcomes between patients achieving MRI and clinical healing. METHODS: A retrospective analysis of perianal fistulizing Crohn's patients treated at one specialist IBD unit was performed. Records were reviewed for patient demographics, disease history, clinical assessments, investigation results, and disease flares. Clinical remission was defined as closure of all baseline fistula openings. Radiological healing was defined as the absence of any T2‐hyperintense sinuses, tracts, or collections. The primary end‐point was rate of MRI healing. The secondary outcome was defined as flare‐free period (time between clinical or radiological healing and patients' first signs/symptoms requiring therapy escalation). RESULTS: A total of 93 patients were included, with a median follow‐up of 4.8 years (interquartile range, 2.4–6 years). Of 44 patients, 22 (50%) achieved clinical remission, while 15 of 93 (16%) achieved radiological healing. Of 22 patients, 10 (45%) with clinical remission had a subsequent disease flare (median time of 7 months) compared with 3 of 15 (20%) patients with MRI healing (median time of 3.6 years). Radiological healing was associated with a significantly longer flare‐free period (P = 0.01). CONCLUSION: Radiological healing occurs less commonly but represents a deeper form of healing, associated with improved long‐term clinical outcomes.
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spelling pubmed-78572822021-02-05 Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era Lee, Tanya Kamm, Michael A Bell, Sally Lust, Mark Brown, Steve Niewiadomski, Ola Basnayake, Chamara Wright, Emily D'Souza, Basil Woods, Rodney Wei, Shu Chen Connell, William Thompson, Alexander Yong, Eric Ding, Nik Sheng JGH Open Original Articles BACKGROUND AND AIM: While the advent of biologic therapy has led to improved outcomes in perianal fistulizing Crohn's disease (pfCD), loss of response is common. Previous studies suggest that patients who achieve radiological healing (with healing of underlying tracts on magnetic resonance imaging [MRI]) have a longer duration of response. The aim of this study was to characterize MRI outcomes of pfCD at a specialist inflammatory bowel disease (IBD) unit and compare the long‐term clinical outcomes between patients achieving MRI and clinical healing. METHODS: A retrospective analysis of perianal fistulizing Crohn's patients treated at one specialist IBD unit was performed. Records were reviewed for patient demographics, disease history, clinical assessments, investigation results, and disease flares. Clinical remission was defined as closure of all baseline fistula openings. Radiological healing was defined as the absence of any T2‐hyperintense sinuses, tracts, or collections. The primary end‐point was rate of MRI healing. The secondary outcome was defined as flare‐free period (time between clinical or radiological healing and patients' first signs/symptoms requiring therapy escalation). RESULTS: A total of 93 patients were included, with a median follow‐up of 4.8 years (interquartile range, 2.4–6 years). Of 44 patients, 22 (50%) achieved clinical remission, while 15 of 93 (16%) achieved radiological healing. Of 22 patients, 10 (45%) with clinical remission had a subsequent disease flare (median time of 7 months) compared with 3 of 15 (20%) patients with MRI healing (median time of 3.6 years). Radiological healing was associated with a significantly longer flare‐free period (P = 0.01). CONCLUSION: Radiological healing occurs less commonly but represents a deeper form of healing, associated with improved long‐term clinical outcomes. Wiley Publishing Asia Pty Ltd 2020-12-20 /pmc/articles/PMC7857282/ /pubmed/33553661 http://dx.doi.org/10.1002/jgh3.12475 Text en © 2020 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Lee, Tanya
Kamm, Michael A
Bell, Sally
Lust, Mark
Brown, Steve
Niewiadomski, Ola
Basnayake, Chamara
Wright, Emily
D'Souza, Basil
Woods, Rodney
Wei, Shu Chen
Connell, William
Thompson, Alexander
Yong, Eric
Ding, Nik Sheng
Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era
title Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era
title_full Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era
title_fullStr Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era
title_full_unstemmed Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era
title_short Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era
title_sort long‐term outcomes of perianal fistulizing crohn's disease in the biologic era
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857282/
https://www.ncbi.nlm.nih.gov/pubmed/33553661
http://dx.doi.org/10.1002/jgh3.12475
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