Factors associated with the achievement of mucosal healing in Crohn's disease: the benefit of endoscopic monitoring in treating to target

Background: Mucosal healing (MH), the proposed treat to target in Crohn's disease (CD), is associated with improved disease outcomes. There are still scant data on factors associated with achieving MH in clinical practice. We evaluated the probability of achieving MH and identified factors predictive of subsequent MH in patients with CD. Methods: This was a retrospective, observational cohort study. A total of 272 patients with CD with serial endoscopy assessment and subsequent therapeutic management were reviewed. The primary outcome was MH. The cumulative incidence of MH and endoscopic improvement was estimated using the Kaplan-Meier method. Factors independently associated with MH were identified using the Cox proportional hazards model. Results: Of the 272 patients, 126 (46.32%) achieved MH after a median follow-up period of 33 months (interquartile range: 27-38 months). Factors independently associated with MH by multivariate analysis were time between endoscopic procedures within 26 weeks (hazard ratio [HR]: 1.56; 95% confidence interval [Cl]: 1.05-3.39), adjustment of medical therapy when MH was not achieved (HR: 2.07; 95% Cl: 1.26-2.33), prior enteric fistula (HR: 0.22; 95% Cl: 0.06-0.91), perianal disease at CD diagnosis (HR: 0.58; 95% Cl: 0.35-0.95), and C-reactive protein normalization within 12 weeks (HR: 3.23; 95% Cl: 1.82-5.88). Similar factors have also been identified for endoscopic improvement. Conclusions: Performing serial endoscopic procedures at a 26-week interval and subsequent adjustment in medical treatment are helpful in achieving MH. Endoscopic monitoring plays an important role in the treating to target of CD.