Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Effectiveness of biologics for endoscopic healing in patients with isolated proximal small bowel Crohn’s disease
Zi-Cheng Huang, Bi-Yao Wang, Bo Peng, Zhong-Cheng Liu, Hui-Xian Lin, Qing-Fan Yang, Jian Tang, Kang Chao, Miao Li, Xiang Gao, Qin Guo
Zi-Cheng Huang, Bi-Yao Wang, Bo Peng, Hui-Xian Lin, Qing-Fan Yang, Jian Tang, Kang Chao, Miao Li, Xiang Gao, Qin Guo, Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Zi-Cheng Huang, Bo Peng, Zhong-Cheng Liu, Qing-Fan Yang, Jian Tang, Kang Chao, Miao Li, Xiang Gao, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Zi-Cheng Huang, Bo Peng, Qing-Fan Yang, Jian Tang, Kang Chao, Miao Li, Xiang Gao, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Bo Peng, Zhong-Cheng Liu, Miao Li, Qin Guo, Department of Small Bowel Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Co-first authors: Zi-Cheng Huang and Bi-Yao Wang.
Author contributions: Huang ZC and Wang BY were involved in the study concept and design, data acquisition, quality control of the data, data analysis and interpretation, statistical analysis, manuscript preparation, editing, and review; Peng B, Liu ZC, Lin HX, Yang QF, Tang J, Chao K, Li M were involved in data acquisition, and quality control of data; Gao X and Guo Q were involved in study concept and design, critical revision of the manuscript, and study supervision; All authors have read and approved the final manuscript.
Supported by the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases, No. 2020B1111170004.
Institutional review board statement: The study was reviewed and approved by the Sixth Affiliated Hospital of Sun Yat-sen University Institutional Review Board (Approval No. 2023ZSLYEC-609).
Informed consent statement: Informed consent from patients was waived because the study was retrospective and all patient data were fully de-identified.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used and/or analyzed during the current study are available from the corresponding author on reasonable request at
guoq83@mail.sysu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Qin Guo, PhD, Professor, Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Erheng Road, Yuancun, Tianhe District, Guangzhou 510000, Guangdong Province, China.
guoq83@mail.sysu.edu.cn
Received: June 29, 2024
Revised: November 30, 2024
Accepted: January 2, 2025
Published online: February 21, 2025
Processing time: 204 Days and 20.1 Hours
BACKGROUND
Endoscopic healing (EH) is a key therapeutic target in Crohn’s disease (CD). Proximal small bowel (SB) lesions in patients with CD are associated with a significant risk of strictures and bowel resection. Assessing SB in patients with CD is necessary because of its significant therapeutic implications. The advent of biologic therapies, including infliximab, ustekinumab, and vedolizumab, has significantly altered CD treatment. However, data on the efficacy of biologics in achieving EH, specifically in the proximal SB of patients with CD, remain limited.
AIM
To assess the effectiveness of biologics for EH in patients with jejunal and/or proximal ileal CD.
METHODS
Between 2017 and 2023, we retrospectively included 110 consecutive patients with isolated proximal SB CD, identified through baseline balloon-assisted enteroscopy. These patients completed 1-year of treatment with infliximab, ustekinumab, or vedolizumab, and underwent a second balloon-assisted enteroscopy at 1 year. Complete EH was defined as a modified Simple Endoscopic Score for CD (SES-CD) of < 3, while EH of the jejunum and proximal ileum was defined as a segmental modified SES-CD of 0.
RESULTS
In total, 64 patients were treated with infliximab, 28 with ustekinumab, and 18 with vedolizumab. The complete EH rate at 1 year was 20.9% (23/110), with 29.6% (19/64) for infliximab, 10.7% (3/28) for ustekinumab, and 5.5% (1/18) for vedolizumab. The median modified SES-CD significantly decreased compared to baseline [5 (2-8) vs 8 (6-9), P < 0.001]. The jejunal and proximal ileal EH rates at 1 year were 30.8% (12/39) and 15.5% (16/103), respectively. Multiple logistic regression analysis showed that stricturing or penetrating disease [odds ratio (OR) = 0.261, 95%CI: 0.087-0.778, P = 0.016], prior exposure to biologics (OR = 0.080, 95%CI: 0.010-0.674, P = 0.020), and moderate-to-severe endoscopic disease (OR = 0.277, 95%CI: 0.093-0.829, P = 0.022) were associated with a lower likelihood of achieving EH at 1 year.
CONCLUSION
Only 20.9% of patients with isolated proximal SB CD achieved complete EH after 1 year of biologic therapy.
Core Tip: Endoscopic healing (EH) is a key treatment target for Crohn’s disease (CD), but limited data are available on isolated proximal small bowel (SB) disease. This retrospective study analyzed the data of patients with isolated proximal SB CD identified through balloon-assisted enteroscopy. We aimed to evaluate the effectiveness of biologics for EH in patients with jejunal and proximal ileal CD at 1 year. The results showed that 20.9% of patients achieved complete EH after 1-year biologic therapy. Failure to achieve complete EH was significantly associated with stricturing or penetrating disease, prior exposure to biologics, and moderate-to-severe endoscopic disease.
