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TOPLINE:
Transmural healing, assessed using faecal calprotectin (FC) levels and intestinal ultrasonography (IUS), was associated with a reduced risk for bowel damage progression and thereby improved long-term outcomes in Crohn’s disease (CD).
METHODOLOGY:
- Researchers conducted a prospective cross-sectional observational study at an inflammatory bowel disease referral centre (February to April 2022 and December 2023 to April 2024) to assess the agreement between FC and IUS in detecting active CD.
- A total of 112 consecutive patients with CD aged 18 years or older underwent scheduled IUS along with stool collection within a week.
- Patients were divided into four categories: Those who achieved transmural healing (normal FC levels < 100 μg/g and normal IUS), IUS healing (elevated FC levels but normal IUS), biochemical remission (normal FC levels but abnormal IUS — signs of active inflammation on IUS), and no healing (abnormal levels for both).
- The primary endpoint was active CD, defined as either abnormal IUS or FC levels exceeding 100 μg/g; secondary endpoints were bowel damage progression, relapse-related drug discontinuation, and the acceptability of monitoring tools.
TAKEAWAY:
- Overall, 44.6% of patients (n = 50; mean age, 39.5 years) achieved transmural healing, 12.5% (n = 14; mean age, 45.5 years) exhibited IUS healing, 16.1% (n = 18; mean age, 45.5 years) reached biochemical remission, and 26.8% (n = 30; mean age, 41 years) showed no healing.
- The agreement between IUS and FC for detecting active CD was poor (71.4%; kappa coefficient, 0.41 ± 0.09).
- Transmural healing was associated with a significantly lower risk for bowel damage progression than no healing (P < .0001); however, biochemical remission (P = .84) and IUS healing (P = .15) did not significantly reduce the risk.
- Patients who achieved transmural healing had a lower risk for relapse-related drug discontinuation than those who achieved biochemical remission (hazard ratio [HR], 0.09; P = .003), IUS healing (HR, 0.11; P = .01), or no healing (HR, 0.09; P = .002). IUS achieved higher patient acceptability scores than FC testing on a 10-point scale (P < .0001).
IN PRACTICE:
“Our work confirmed the potential complementarity of Fcal [faecal calprotectin] and transmural evaluation,” the authors of the study wrote. “We confirmed that IUS is better accepted by patients with CD,” they added.
SOURCE:
This study was led by Julie Huet, MD, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastroentérologie, Université Clermont Auvergne, Clermont-Ferrand, France. It was published online on April 25, 2025, in Inflammatory Bowel Diseases.
LIMITATIONS:
This study lacked central reading for IUS results, had a single-centre design, and relied on one sonographer. Moreover, the follow-up duration was short, with a relatively low frequency of events and small sample size in some subgroups. Endoscopic or MRI evaluations, although intentionally performed for recruitment, could have offered valuable insights for inflammatory bowel disease physicians.
DISCLOSURES:
This study did not receive any specific funding. One author reported receiving consulting fees, lecture fees, and research grants from various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
