P172 Histological healing is associated with decreased clinical relapse in patients with ileal Crohn’s disease
Notice bibliographique
Résumé
Mucosal healing has emerged as a goal of maintenance therapy in patients with Crohn’s disease and is associated with improved clinical outcomes. The role of histological healing is less well defined. This study examines if histological healing is associated with improved clinical outcomes in patients with Crohn’s disease confined to the terminal ileum. Patients with confirmed Crohn’s disease isolated to the ileum who had a colonoscopy between September 2005 and June 2015 with biopsies taken from the colon and ileum were identified. Those in clinical remission at the time of colonoscopy were included. Demographic and clinical data were collected from case records. The ileum was evaluated for endoscopic mucosal healing (no ulceration) and histological healing (no active inflammation with no erosions, ulceration or neutrophil infiltration). The primary outcome was clinical relapse defined by an HBI > 4, medication escalation or hospitalisation secondary to disease activity. Clinical relapse-free survival was compared between patients with and without histological and mucosal healing. Predictors of clinical relapse-free survival were determined using Kaplan–Meier analysis, log-rank test and Cox proportional hazard model. Of 101 patients, 22 were diagnosed at <16 years old, 23 (23%) patients had an inflammatory Crohn’s disease phenotype (Montreal classification B1), 52 (52%) had penetrating disease (B2) and 25 (25%) stricturing disease (B3). At colonoscopy, 65 (64%) patients had mucosal healing of the terminal ileum and 56 (55%) patients had histological healing on biopsy. The level of agreement between mucosal and histologic activity was fair (agreement for 63% of samples, K = 0.2437, p = 0.0064). 46 (46%) patients experienced clinical relapse with 17 patients requiring hospitalisation and 6 patients requiring surgical intervention at median time of 1.7 years (range 0.003–7.392). On univariate analysis, histological healing (p = 0.0166) was associated with decreased rates of clinical relapse. Mucosal healing (p = 0.0735) trended toward a decreased risk of clinical relapse. No other disease- or medication-related characteristics were significantly associated with clinical relapse. On multivariate analysis, only failure of histological healing was associated with risk of clinical relapse (HR 1.85 (95% CI: 1.00–3.44), p = 0.050). In patients with ileal Crohn’s disease in clinical remission, histological healing is associated with a decreased risk of clinical relapse and is more predictive than endoscopic mucosal healing. We describe a level of “deeper remission” with associated superior clinical outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».