P-016 YI Mucosal Healing Is Associated with Improved Long-Term Outcomes in Crohnʼs Disease
Bibliographic record
Abstract
Treating to achieve clinical remission (CR) has neither been shown to improve Crohn's disease (CD) outcomes nor alter the natural course of disease. It is unclear whether targeting more objective measures like mucosal healing (MH) is associated with improved long-term outcomes. We performed a systematic review and meta-analysis to identify and analyze studies comparing long-term outcomes in patients with active CD who achieve early MH compared to those who do not. A systematic literature search of PubMed, Embase, and Cochrane Library was performed to identify observational or interventional studies with a prospective cohort of active CD patients that included long-term outcomes of patients who achieved MH compared to those who did not. The primary outcome was long-term clinical remission (CR). Secondary outcomes included CD-related surgery-free rate and long-term MH rate. Pooled odds-ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome. Twelve high-quality studies with 673 active CD patients were eligible for inclusion in the meta-analysis. Patients who achieved early MH had a pooled OR of 2.80 (95% CI, 1.91–4.10) for achieving long-term CR, 2.22 (95% CI, 0.86–5.69) for CD-related surgery-free rate, and 14.30 (95% CI, 5.57–36.74) for long-term MH. Sensitivity analyses suggested no significant difference in outcomes if MH was achieved on biologics compared to non-biologics. Achieving complete MH (SES-CD of 0 and/or complete absence of mucosal ulceration) was associated with even higher pooled ORs for achieving long-term CR and MH. There was no publication bias and no significant heterogeneity among the included studies. This meta-analysis of over 670 active CD patients suggests that achieving MH, either with biologic or non-biologic therapy, is associated with improved long-term outcomes at 1 year and beyond. The extent to which poor prognostic factors such as fistulizing disease, early surgical intervention, early corticosteroid use, and early age at diagnosis, among others, predict disease course relative to the severity of mucosal lesions remains to be evaluated in well-designed prospective trials. Based on our findings and in the absence of published prospective randomized control trials, it seems reasonable to target MH (in addition to clinical improvement) as a goal of CD treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.021 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".