Mucosal Healing in Clinical Practice: A Single-Center Pediatric IBD Experience

Savini L. Santha, Prabhu Rv Shankar, Anqi Pan, Bess Schoen, Subra Kugathasan, Cary G. Sauer

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Mucosal healing (MH) is associated with improved clinical outcomes in patients with Crohn's disease (CD) and ulcerative colitis (UC). MH as a target for treatment has been suggested, although there is little pediatric data. The goal of this study was to evaluate MH in clinical practice in pediatric patients with inflammatory bowel disease in clinical remission. Methods: A retrospective review of electronic health record data was performed on all patients with CD or UC who underwent at least 2 colonoscopies from 2010 through 2016. Only patients in clinical remission undergoing a scope for MH were included in our study. The incidence of MH and histologic healing (HH) was analyzed, along with cumulative rates of MH in each group. MH was defined by both physician assessment of MH and an endoscopic score of zero for CD and UC. Results: A total of 76 patients with CD and 28 patients with UC underwent at least one MH scope while in clinical remission. Of the 76 patients with CD, 51 patients (67%) demonstrated MH by physician assessment, 34 patients (45%) demonstrated MH by a simple endoscopic score for CD of zero, and 35 patients (46%) demonstrated HH. Of the 28 patients with UC, 20 patients (71%) demonstrated MH by physician assessment, 10 patients (36%) demonstrated MH by a Mayo score of zero, and 10 patients (36%) demonstrated HH. Nineteen patients underwent a second MH scope and 11 (58%) demonstrated MH by physician assessment, 7 patients (37%) demonstrated MH by simple endoscopic score for CD or Mayo scores of zero, and 5 patients (26%) demonstrated HH. Of those patients with active disease, 21 of 25 patients with CD underwent escalation of therapy, whereas 8 of 8 patients with UC underwent escalation of therapy. Cumulative rates of MH when defined by physician assessment were 79% (60 of 76 patients) in CD and 79% (22 of 28 patients) in UC. Conclusions: MH is feasible in pediatric CD and UC, and rates of cumulative MH in pediatric patients are similar to previously published adult data. In children with inflammatory bowel disease in clinical remission, approximately one-third demonstrate active disease at endoscopy.

Original languageEnglish (US)
Pages (from-to)1447-1453
Number of pages7
JournalInflammatory Bowel Diseases
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Pediatrics
Crohn Disease
Ulcerative Colitis
Physicians
Inflammatory Bowel Diseases
Electronic Health Records
Colonoscopy
Endoscopy

Keywords

  • Crohn's disease
  • inflammatory bowel disease
  • mucosal healing
  • pediatric
  • ulcerative colitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Mucosal Healing in Clinical Practice : A Single-Center Pediatric IBD Experience. / Santha, Savini L.; Shankar, Prabhu Rv; Pan, Anqi; Schoen, Bess; Kugathasan, Subra; Sauer, Cary G.

In: Inflammatory Bowel Diseases, Vol. 23, No. 8, 01.08.2017, p. 1447-1453.

Research output: Contribution to journalArticle

Santha, Savini L. ; Shankar, Prabhu Rv ; Pan, Anqi ; Schoen, Bess ; Kugathasan, Subra ; Sauer, Cary G. / Mucosal Healing in Clinical Practice : A Single-Center Pediatric IBD Experience. In: Inflammatory Bowel Diseases. 2017 ; Vol. 23, No. 8. pp. 1447-1453.
@article{1a3ec2811db447668f8bb09c7fd85802,
title = "Mucosal Healing in Clinical Practice: A Single-Center Pediatric IBD Experience",
abstract = "Background: Mucosal healing (MH) is associated with improved clinical outcomes in patients with Crohn's disease (CD) and ulcerative colitis (UC). MH as a target for treatment has been suggested, although there is little pediatric data. The goal of this study was to evaluate MH in clinical practice in pediatric patients with inflammatory bowel disease in clinical remission. Methods: A retrospective review of electronic health record data was performed on all patients with CD or UC who underwent at least 2 colonoscopies from 2010 through 2016. Only patients in clinical remission undergoing a scope for MH were included in our study. The incidence of MH and histologic healing (HH) was analyzed, along with cumulative rates of MH in each group. MH was defined by both physician assessment of MH and an endoscopic score of zero for CD and UC. Results: A total of 76 patients with CD and 28 patients with UC underwent at least one MH scope while in clinical remission. Of the 76 patients with CD, 51 patients (67{\%}) demonstrated MH by physician assessment, 34 patients (45{\%}) demonstrated MH by a simple endoscopic score for CD of zero, and 35 patients (46{\%}) demonstrated HH. Of the 28 patients with UC, 20 patients (71{\%}) demonstrated MH by physician assessment, 10 patients (36{\%}) demonstrated MH by a Mayo score of zero, and 10 patients (36{\%}) demonstrated HH. Nineteen patients underwent a second MH scope and 11 (58{\%}) demonstrated MH by physician assessment, 7 patients (37{\%}) demonstrated MH by simple endoscopic score for CD or Mayo scores of zero, and 5 patients (26{\%}) demonstrated HH. Of those patients with active disease, 21 of 25 patients with CD underwent escalation of therapy, whereas 8 of 8 patients with UC underwent escalation of therapy. Cumulative rates of MH when defined by physician assessment were 79{\%} (60 of 76 patients) in CD and 79{\%} (22 of 28 patients) in UC. Conclusions: MH is feasible in pediatric CD and UC, and rates of cumulative MH in pediatric patients are similar to previously published adult data. In children with inflammatory bowel disease in clinical remission, approximately one-third demonstrate active disease at endoscopy.",
keywords = "Crohn's disease, inflammatory bowel disease, mucosal healing, pediatric, ulcerative colitis",
author = "Santha, {Savini L.} and Shankar, {Prabhu Rv} and Anqi Pan and Bess Schoen and Subra Kugathasan and Sauer, {Cary G.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1097/MIB.0000000000001176",
language = "English (US)",
volume = "23",
pages = "1447--1453",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "8",

}

TY - JOUR

T1 - Mucosal Healing in Clinical Practice

T2 - A Single-Center Pediatric IBD Experience

AU - Santha, Savini L.

AU - Shankar, Prabhu Rv

AU - Pan, Anqi

AU - Schoen, Bess

AU - Kugathasan, Subra

AU - Sauer, Cary G.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: Mucosal healing (MH) is associated with improved clinical outcomes in patients with Crohn's disease (CD) and ulcerative colitis (UC). MH as a target for treatment has been suggested, although there is little pediatric data. The goal of this study was to evaluate MH in clinical practice in pediatric patients with inflammatory bowel disease in clinical remission. Methods: A retrospective review of electronic health record data was performed on all patients with CD or UC who underwent at least 2 colonoscopies from 2010 through 2016. Only patients in clinical remission undergoing a scope for MH were included in our study. The incidence of MH and histologic healing (HH) was analyzed, along with cumulative rates of MH in each group. MH was defined by both physician assessment of MH and an endoscopic score of zero for CD and UC. Results: A total of 76 patients with CD and 28 patients with UC underwent at least one MH scope while in clinical remission. Of the 76 patients with CD, 51 patients (67%) demonstrated MH by physician assessment, 34 patients (45%) demonstrated MH by a simple endoscopic score for CD of zero, and 35 patients (46%) demonstrated HH. Of the 28 patients with UC, 20 patients (71%) demonstrated MH by physician assessment, 10 patients (36%) demonstrated MH by a Mayo score of zero, and 10 patients (36%) demonstrated HH. Nineteen patients underwent a second MH scope and 11 (58%) demonstrated MH by physician assessment, 7 patients (37%) demonstrated MH by simple endoscopic score for CD or Mayo scores of zero, and 5 patients (26%) demonstrated HH. Of those patients with active disease, 21 of 25 patients with CD underwent escalation of therapy, whereas 8 of 8 patients with UC underwent escalation of therapy. Cumulative rates of MH when defined by physician assessment were 79% (60 of 76 patients) in CD and 79% (22 of 28 patients) in UC. Conclusions: MH is feasible in pediatric CD and UC, and rates of cumulative MH in pediatric patients are similar to previously published adult data. In children with inflammatory bowel disease in clinical remission, approximately one-third demonstrate active disease at endoscopy.

AB - Background: Mucosal healing (MH) is associated with improved clinical outcomes in patients with Crohn's disease (CD) and ulcerative colitis (UC). MH as a target for treatment has been suggested, although there is little pediatric data. The goal of this study was to evaluate MH in clinical practice in pediatric patients with inflammatory bowel disease in clinical remission. Methods: A retrospective review of electronic health record data was performed on all patients with CD or UC who underwent at least 2 colonoscopies from 2010 through 2016. Only patients in clinical remission undergoing a scope for MH were included in our study. The incidence of MH and histologic healing (HH) was analyzed, along with cumulative rates of MH in each group. MH was defined by both physician assessment of MH and an endoscopic score of zero for CD and UC. Results: A total of 76 patients with CD and 28 patients with UC underwent at least one MH scope while in clinical remission. Of the 76 patients with CD, 51 patients (67%) demonstrated MH by physician assessment, 34 patients (45%) demonstrated MH by a simple endoscopic score for CD of zero, and 35 patients (46%) demonstrated HH. Of the 28 patients with UC, 20 patients (71%) demonstrated MH by physician assessment, 10 patients (36%) demonstrated MH by a Mayo score of zero, and 10 patients (36%) demonstrated HH. Nineteen patients underwent a second MH scope and 11 (58%) demonstrated MH by physician assessment, 7 patients (37%) demonstrated MH by simple endoscopic score for CD or Mayo scores of zero, and 5 patients (26%) demonstrated HH. Of those patients with active disease, 21 of 25 patients with CD underwent escalation of therapy, whereas 8 of 8 patients with UC underwent escalation of therapy. Cumulative rates of MH when defined by physician assessment were 79% (60 of 76 patients) in CD and 79% (22 of 28 patients) in UC. Conclusions: MH is feasible in pediatric CD and UC, and rates of cumulative MH in pediatric patients are similar to previously published adult data. In children with inflammatory bowel disease in clinical remission, approximately one-third demonstrate active disease at endoscopy.

KW - Crohn's disease

KW - inflammatory bowel disease

KW - mucosal healing

KW - pediatric

KW - ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85026466821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026466821&partnerID=8YFLogxK

U2 - 10.1097/MIB.0000000000001176

DO - 10.1097/MIB.0000000000001176

M3 - Article

C2 - 28644180

AN - SCOPUS:85026466821

VL - 23

SP - 1447

EP - 1453

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 8

ER -