Crohn's disease (CD) is a chronic relapsed inflammatory bowel disease (IBD) that often leads to complications such as stenosis, abscesses, or fistula.
drugs used to treat CD include corticosteroids, thiopental (AZA), methotrexate and biologics.
With the advent of the first biological agent, anti-tumor necrotizer (anti-TNF) monoclonal antibody inixixab (IFX), "targeted therapy" has become the main treatment strategy used for IBD in recent years.
the goal of treatment has shifted from controlling clinical symptoms to achieving mucous membrane healing (MH) MH with better long-term results, usually referring to ulcers and decay that are not evaluated by endoscopy.
, however, there is no valid definition of MH in IBD.
MH's standard and objective definitions are carried out through the endoscopic activity index (including the Simple Endoscopic Index (SES-CD) for Crohn's disease and the Endoscopic Index (CDEIS) for the severity of Crohn's disease, which are widely used in clinical trials and practices.
VERSIFY study showed that the MH rate of the cross and right colons was higher than that of the left colon and the return intestine when treated with Vido bead monotherapy.
as the first biologic agent, IFX has been used worldwide to treat CD for more than 20 years.
, however, the efficacy of MH in different back colon segments (i.e., rectum, B colon/left colon, cross colon, right colon and end of rectum) is not clear.
, the study looked at differences in endoscopic MH in different colon segments in CD patients treated with IFX.
researchers collected clinical data on patients with active back colon CD between January 2012 and December 2018.
all patients received IFX treatment for at least 30 weeks.
at baselines, 14/22 and 30/38 weeks, MH in five colon segments was assessed with a simple endoscopic score (SES-CD) of the CD.
the mixing factors, the SES-CD values are analyzed by the hybrid effect model.
the study ended up with a total of 101 eligible patients.
the severity of the baseline endoscopy is similar in each paragraph.
at 30/38 weeks, the largest changes in cross colon SES-CD ulcer size and ulcer surface sub-scores were -94.29% and -94.32% (p .lt;0.0001).
the stenosis of all patients was mainly manifested in the right colon (12 / 29, 41.38%).
at 30/38 weeks, the change in the narrow sub-score of right colon SES-CD was -6.25%, compared to -71.88% at 14/22 weeks (p s 0.0030).
at 30/38 weeks, the highest MH (CMH) rate of the colon was the highest, at 81.2%, while the CMH at the end of the rectum was the lowest, with a rate of 45.6%.
, the improvement of the rectum was negatively related to disease progressity (p s 0.011).
, the authors concluded: During IFX therapy, different intestinal segments in the CD showed varying degrees of endoscopic MH.
showed the highest CMH rate, and the right narrow colon showed the worst improvement rate.
, CD patients at different lesions should be treated with different biologics.