Treat-to-target in Crohn’s disease:Will transmural healing become a therapeutic endpoint?

摘要

Crohn’s disease(CD)represents a chronic transmural inflammatory condition of the gastrointestinal tract,which usually leads to structural damage and significant disability.Deep remission-defined by both clinical and endoscopic remission,signifying mucosal healing-represents the current endpoint in the treat-to-target strategy,significantly improving patients’long-term outcomes.Transmural healing(TH)could be a more effective target,but this possibility remains unclear.This narrative review aims to critically review and summarize the available literature relating TH to long-term outcomes,being the first of its kind and to the best of the author’s knowledge.A systematic literature search(from inception to March 31 2018)was performed,using multiple databases,and identifying seven full-text manuscripts.In those studies,long-term favorable outcomes(≥52 wk)included sustained clinical remission,as well as fewer therapeutic changes,CD-related hospitalizations,and surgeries.Despite heterogeneous design and methodological limitations,six of the studies demonstrated that TH or intestinal healing(TH plus mucosal healing)were predictive for the aforementioned favorable outcomes.Therefore,TH may become a reasonable therapeutic target and be included in the concept of deep remission.Further prospective,well-designed,multicenter trials aiming to better define the role of TH in personalized therapy for CD and to determine the long-term influence of TH on bowel damage and disability are warranted.