Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 501-513
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.501
Treat-to-target in Crohn’s disease: Will transmural healing become a therapeutic endpoint?
Elena Daniela Serban
Elena Daniela Serban, 2nd Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Hospital for Children, Cluj-Napoca 400177, Romania
Author contributions: Serban ED conceived of and designed the study performed the data collection, extraction, analysis, and interpretation, prepared the manuscript performed the editing and critical revision of the manuscript through to its final version for submission.
Conflict-of-interest statement: The author has no potential conflicts of interest relevant to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elena Daniela Serban, MD, PhD, Associate Professor, Pediatric Gastroenterologist, 2nd Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Hospital for Children, 5 Crisan Street, Cluj-Napoca 400177, Romania. daniela.serban@umfcluj.ro
Telephone: +40-264-532216 Fax: +40-264-590478
Received: June 4, 2018
Peer-review started: June 25, 2018
First decision: August 3, 2018
Revised: August 17, 2018
Accepted: October 8, 2018
Article in press: October 8, 2018
Published online: October 26, 2018
Processing time: 146 Days and 5.7 Hours
Abstract

Crohn’s disease (CD) represents a chronic transmural inflammatory condition of the gastrointestinal tract, which usually leads to structural damage and significant disability. Deep remission - defined by both clinical and endoscopic remission, signifying mucosal healing - represents the current endpoint in the treat-to-target strategy, significantly improving patients’ long-term outcomes. Transmural healing (TH) could be a more effective target, but this possibility remains unclear. This narrative review aims to critically review and summarize the available literature relating TH to long-term outcomes, being the first of its kind and to the best of the author’s knowledge. A systematic literature search (from inception to March 31 2018) was performed, using multiple databases, and identifying seven full-text manuscripts. In those studies, long-term favorable outcomes (≥ 52 wk) included sustained clinical remission, as well as fewer therapeutic changes, CD-related hospitalizations, and surgeries. Despite heterogeneous design and methodological limitations, six of the studies demonstrated that TH or intestinal healing (TH plus mucosal healing) were predictive for the aforementioned favorable outcomes. Therefore, TH may become a reasonable therapeutic target and be included in the concept of deep remission. Further prospective, well-designed, multicenter trials aiming to better define the role of TH in personalized therapy for CD and to determine the long-term influence of TH on bowel damage and disability are warranted.

Keywords: Treat to target; Cross sectional imaging; Deep remission; Transmural healing; Intestinal healing; Long-term outcomes; Bowel damage; Crohn’s disease

Core tip: Crohn’s disease (CD) represents a chronic transmural inflammatory condition of the gastrointestinal tract, potentially leading to structural damage and disability. Deep remission (clinical and endoscopic remission), the current therapeutic goal, significantly improves patients’ long-term outcomes. Transmural healing (TH) could be a more effective target. Therefore, this narrative review (the first of its kind, to the best of the author’s knowledge) aims to provide the currently available scientific evidence on the predictive role of TH for long-term outcomes (clinical remission, therapeutic changes, CD-related hospitalizations and surgeries) and to establish whether TH should become a therapeutic endpoint in the treat-to-target strategy.