Systematic review on drug and diet-induced endoscopic remission in Crohn's disease

• Type: Another Publication in an International Scientific Journal
• Date: 2009

Authors

Pedro Pimentel-Nunes (Author) FMUP; Mario Dinis Ribeiro (Author) FMUP; Magro F (Author) FMUP

Journal

Title: European Journal of Gastroenterology & Hepatology

Vol. 21 No. 2

Pages: 491-503

ISSN: 0954-691X

Publisher: Lippincott Williams & Wilkins

Indexing

ISI Web of Knowledge - 5 Citations

Scopus - 10 Citations

Other information

Authenticus ID: P-003-KBB

DOI: 10.1097/meg.0b013e3283196b03

Abstract (EN): Background Neither the rate of endoscopic remission (ER) in Crohn's disease (CD) after therapy nor its role in patients' prognosis is well defined. Aim To systematically review the current evidence on the proportion of ER of different therapies in patients with Crohn's disease and its relation with clinical outcomes. Methods Databases (MEDLINE and Cochrane) and manual search of manuscripts found 482 titles. Data was extracted from 24 manuscripts. Results Ten different methods were used to assess endoscopic outcomes. Corticosteroids induced a pooled proportion of patients with no ulcerations at endoscopic follow-up of 17% (95% confidence interval: 12-22%) lower than that found with infliximab [44% (34-53%)], diet [43% (33-52%)] or azathioprine [54% (38-69%)] (P<0.0001). Enteric diets and infliximab were associated with 61% (52-70%) and 70% (62-78%) reduction in endoscopic scores, respectively, significantly higher than corticosteroids [45% (39-52%)] (P=0.01) and placebo [12% (1-22%)] (P<0.0001). A linear relation between ER and clinical remission was observed with infliximab (r(2)=0.931). Only one study tried to assess the direct correlation between ER and patients' prognosis. Conclusion Available treatments induce significant endoscopic improvement. However, pooled results should be cautiously interpreted because of the diversity of measurements. A better definition of endoscopic outcomes and a prospective validation of their relevance in patients with Crohn's disease are needed. Eur J Gastroenterol Hepatol 21:491-503 (c) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 13