Asian Journal of Research and Reports in Gastroenterology

Predictive Factors of Endoscopic Mucosal Healing in Patients with Chronic Inflammatory Bowel Diseases on Biotherapy

Tarik Adioui

Mohammed V Military Hospital, Morocco.

Imane Mouslim *

Mohammed V Military Hospital, Morocco.

Fouad Nejjari

Mohammed V Military Hospital, Morocco.

Abdelfettah Touibi

Mohammed V Military Hospital, Morocco.

Sanaa Berrag

Mohammed V Military Hospital, Morocco.

Mouna Tamzaourte

Mohammed V Military Hospital, Morocco.

*Author to whom correspondence should be addressed.

---

Abstract

Achieving mucosal healing is the main goal in the treatment of patients with chronic inflammatory bowel diseases (Crohn's disease and Ulcerative Colitis). Nevertheless, mucosal healing predictors after medical treatment remain unknown. The purpose of this study was to determine the rates of mucosal healing and to characterize its predictive factors in patients with IBD treated with Anti-TNF alpha. We conducted a retrospective descriptive and analytical study between January 2019 and March 2022 in the hepato-gastroenterology I department, within the Mohamed V Military Instruction Hospital in Rabat. We collected demographic, clinical, and biological data of patients being treated for IBD with anti TNF alpha therapy, and who have undergone a colonoscopy before initiating treatment and after 1-year of treatment. In this study, mucosal healing was defined as the absence of ulcerated lesions during the 1-year follow-up colonoscopy. Among 60 patients on anti TNF-alfa therapy for IBD; 43 were included in our study with 10 patients having Ulcerative Colitis and 33 having Crohn’s Disease. Overall, 22 patients had mucosal healing (approximatively 51%): 60% in the UC group and 48,50% in the CD group. Regarding associated factors, in all patients, fecal calprotectin was retained as the only significant predictive factor of mucosal healing. The overall rate of endoscopic mucosal healing in our study was of 51,20% with faecal calprotectin being identified at follow-up coloscopy as a predictive factor. Nevertheless, none of the studied factors were retained when the two groups were analyzed separately.

Keywords: Chronic inflammatory bowel diseases, mucosal healing, anti-TNF alpha

---

---

---

References

Cintolo M. Mucosal healing in inflammatory bowel disease: Maintain or de-escalate therapy. WJGP. 2016;7(1):1.

DOI: 10.4291/wjgp.v7.i1.1

Rutgeerts P, et al. Adalimumab induces and maintains mucosal healing in patients with crohn’s disease: Data from the extend trial. Gastroenterology, 2012;142(5):1102-1111.

DOI: 10.1053/j.gastro.2012.01.035

Peyrin-Biroulet L, et al. Results from the 2nd scientific workshop of the ECCO (I): Impact of mucosal healing on the course of inflammatory bowel disease. Journal of Crohn’s and Colitis. 2011;5(5):477‑483.

DOI: 10.1016/j.crohns.2011.06.009

Schnitzler F, et al. Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in crohn’s disease. Inflamm Bowel Dis. 2009;15(9):1295‑1301.

DOI: 10.1002/ibd.20927

D’haens G, et al. Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in crohn’s disease: A European multicenter trial. Gastroenterology. 1999;116(5):1029‑1034.

DOI: 10.1016/s0016-5085(99)70005-3

Colombel JF, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141(4): 1194‑1201.

DOI: 10.1053/j.gastro.2011.06.054

Ordás I, Feagan BG, Sandborn WJ. Early use of immunosuppressives or TNF antagonists for the treatment of crohn’s disease: Time for a change. Gut. 2011; 60(12):1754‑1763.

DOI: 10.1136/gutjnl-2011-300934

Klenske E, Bojarski C, Waldner M, Rath T, Neurath MF, Atreya R. Targeting mucosal healing in Crohn’s disease: What the clinician needs to know. Therap Adv Gastroenterol. 2019;12:175628481985686.

DOI: 10.1177/1756284819856865

Elhag DA, et al. Inflammatory bowel disease treatments and predictive biomarkers of therapeutic response. IJMS. 2022;23(13):6966.

DOI: 10.3390/ijms23136966

Sipponen T, et al. Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for crohn’s disease. Inflamm Bowel Dis. 2008;14(10):1392‑1398.

DOI: 10.1002/ibd.20490

Colombel JF, et al. Infliximab, azathioprine, or combination therapy for crohn’s disease. N Engl J Med. 2010;362(15):1383‑1395.

DOI: 10.1056/NEJMoa0904492

Kiss LS, et al. Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn’s disease. Aliment Pharmacol Ther. 2011;34(8): 911‑922.

DOI: 10.1111/j.1365-2036.2011.04827.x