Ileal and Rectal Ulcers Heal Slower and May Be More Refractory to Therapy Than Colonic Lesions in Crohn’s Disease
Monika Fischer, MD, reviewing Narula N, et al. Am J Gastroenterol 2020 Aug.
Researchers performed a post hoc analysis of endoscopic outcomes in participants of the pivotal SONIC trial that compared the efficacy of azathioprine, infliximab, and the combination of the two treatments for induction and maintenance of remission in Crohn’s disease. They compared 172 patients’ baseline and week 26 endoscopic findings using the Crohn’s Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn’s Disease (SES-CD). They found that ileal ulcers were less likely to heal than colonic ulcers in any segment of the colon by week 26 (P<.0001). Large ileal and rectal ulcers (>2 cm) were less likely to heal compared with smaller ulcers (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.11–0.89 and OR, 0.26; 95% CI, 0.08–0.80, respectively), whereas the size of colonic ulcers did not impact achievement of endoscopic remission. Deep ileal and rectal ulcers were even less likely (about 10-fold less likely) to heal compared to superficial ulcers. Surprisingly, high SES-CD scores (≥16) or CDEIS scores (≥12), denoting severe inflammation at baseline, did not affect the rate of endoscopic healing by week 26.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Narula N, Wong ECL, Aruljothy A, et al. Ileal and rectal ulcer size affects the ability to achieve endoscopic remission: a post hoc analysis of the SONIC trial. Am J Gastroenterol 2020;115:1236–1245. (https://doi.org/10.14309/ajg.0000000000000617)