TY - JOUR
T1 - Targeting the gut layers in Crohn's disease
T2 - mucosal or transmural healing?
AU - Zacharopoulou, Eirini
AU - Craviotto, Vincenzo
AU - Fiorino, Gionata
AU - Furfaro, Federica
AU - Zilli, Alessandra
AU - Gilardi, Daniela
AU - Peyrin-Biroulet, Laurent
AU - Danese, Silvio
AU - Allocca, Mariangela
PY - 2020/9
Y1 - 2020/9
N2 - INTRODUCTION: Although the landmark of Crohn's Disease (CD) is the transmural inflammation, mucosal healing (MH), which is assessed by colonoscopy, is currently the gold standard of CD management. Transmural healing (TH) is a new concept evaluated by cross-sectional imaging (CSI) techniques, such as bowel ultrasound (US), computed tomography enterography (CTE), and magnetic resonance enterography (MRE). Little is known about the clinical significance of persisting mural disease and the predictive value of complete TH.AREAS COVERED: The authors reviewed the available literature on TH and its meaning as predictor of long-term outcomes in CD, to explore if TH may be a better target compared to MH in CD patients, in terms of disease outcome, such as medication changes, hospitalization, or surgery.EXPERT OPINION: Some evidence suggests that achieving TH has a predictive value in CD management and correlates with better disease outcome than MH, although existing studies are few and with limitations. A definitive definition of TH is not yet established and the frequency or the preferred modality of TH evaluation remains unclear. Implementing TH in treat-to-target approach may enable stricter disease monitoring with noninvasive methods and finally change the disease course, preventing irreversible bowel damage.
AB - INTRODUCTION: Although the landmark of Crohn's Disease (CD) is the transmural inflammation, mucosal healing (MH), which is assessed by colonoscopy, is currently the gold standard of CD management. Transmural healing (TH) is a new concept evaluated by cross-sectional imaging (CSI) techniques, such as bowel ultrasound (US), computed tomography enterography (CTE), and magnetic resonance enterography (MRE). Little is known about the clinical significance of persisting mural disease and the predictive value of complete TH.AREAS COVERED: The authors reviewed the available literature on TH and its meaning as predictor of long-term outcomes in CD, to explore if TH may be a better target compared to MH in CD patients, in terms of disease outcome, such as medication changes, hospitalization, or surgery.EXPERT OPINION: Some evidence suggests that achieving TH has a predictive value in CD management and correlates with better disease outcome than MH, although existing studies are few and with limitations. A definitive definition of TH is not yet established and the frequency or the preferred modality of TH evaluation remains unclear. Implementing TH in treat-to-target approach may enable stricter disease monitoring with noninvasive methods and finally change the disease course, preventing irreversible bowel damage.
U2 - 10.1080/17474124.2020.1780914
DO - 10.1080/17474124.2020.1780914
M3 - Article
C2 - 32515627
VL - 14
SP - 775
EP - 787
JO - Expert Review of Gastroenterology and Hepatology
JF - Expert Review of Gastroenterology and Hepatology
SN - 1747-4124
IS - 9
ER -