P0763 - Histologic Healing in Crohn's Disease Is Not Associated With Long Term Outcomes

Louis J. Levine, MD, MEd¹, Yuanxin Liang, MD², Chandler McMillan, BA³, Dhanpat Jain, MD², Gamal Mohamed, PhD⁴, Leena A.. Almohsen, ⁴, Danah A.. Alsadoun, ⁴, Jill Gaidos, MD, FACG², Deborah D. Proctor, MD⁵, Badr Al-Bawardy, MD^6
1Yale School of Medicine, New Haven, CT; ²Yale University, New Haven, CT; ³Yale University School of Medicine, New Haven, CT; ⁴King Faisal Specialist Hospital, Riyadh, Ar Riyad, Saudi Arabia; ⁵Yale University, Durham, CT; ⁶King Faisal Specialist Hospital and Research Center, Riyadh, Ar Riyad, Saudi Arabia

Introduction: In ulcerative colitis (UC), histologic healing (HH) has been associated with favorable outcomes, but less is known regarding HH in Crohn's disease (CD). We aimed to evaluate the clinical significance of achieving HH in patients with CD.

Methods: This is a single center, retrospective review of CD patients age ≥ 18 from 1/1/2012-7/1/2022. Only patients with endoscopic healing (defined as the absence of ulcers or erosions) were included. Pathology slides were manually re-reviewed by a blinded gastrointestinal pathologist and each colonic segment and ileal biopsies were scored for activity (0 = normal, 1 = < 50% crypts with neutrophils, 2 = > 50% crypts with neutrophils, 3 = ulceration or erosion) and chronicity based on number of non-neutrophil inflammatory cells/high power field (0 = up to 100/HPF, 0.5 = up to 200/HPF, 1 = up to 300/HPF, 2 = up to 500/HPF, 3 = > 500/HPF). HH was defined as a score of 0 for activity regardless of chronicity score. For each patient, the highest scored segment was used to determine HH status.

The primary outcome was a composite adverse outcome defined as occurrence of any of the following: steroid initiation, CD-related emergency department visits or hospitalizations, or surgeries. Secondary outcomes included occurrence of any individual component of the primary outcome or relapse on subsequent endoscopy.

Results: A total of 111 CD patients were included. The median age was 55 years [interquartile range (IQR) 39-67], 59.5% were female, 26.1% had perianal disease, 13.5% had prior bowel resection, and 53 patients were on biologics (81.1% anti-TNF agents).

The overall rate of HH in the cohort was 49.5% (55/111). The median disease duration was significantly longer in the HH group compared to the non-HH group (18 vs. 12.5 years, p = 0.023). Otherwise, there were no significant differences between the groups in terms of baseline characteristics, disease characteristics, or medication factors (Table 1). The primary outcome occurred in 32.7% in the HH group vs. 28.6 in the non-HH group (p=0.635). There were no significant differences between the groups in terms of secondary outcomes (Figure 1).

Discussion: In contrast to HH in UC, our study found no impact of HH on outcomes in patients with CD. Our study is strengthened by blinded manual re-review of pathology slides. Assessment of HH in CD is limited by potential sampling error (considering the patchiness of the disease) and lack of standardized histologic grading criteria.




Disclosures:


Louis J. Levine, MD, MEd¹, Yuanxin Liang, MD², Chandler McMillan, BA³, Dhanpat Jain, MD², Gamal Mohamed, PhD⁴, Leena A.. Almohsen, ⁴, Danah A.. Alsadoun, ⁴, Jill Gaidos, MD, FACG², Deborah D. Proctor, MD⁵, Badr Al-Bawardy, MD⁶. P0763 - Histologic Healing in Crohn's Disease Is Not Associated With Long Term Outcomes, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.