Assessing Transmural Healing and Response in Patients with Crohn's Disease

A study published in Clinical Gastroenterology and Hepatology aimed to develop and validate a scoring system—the modified Clermont score (C-score)—for assessing transmural healing and transmural response in Crohn’s disease (CD), and to evaluate their relationship with favorable CD outcomes.

The DEVISE-CD project included 2 retrospective cohorts (274 and 224 patients) and 1 prospective cohort (46 patients). The primary endpoints were time to bowel damage progression and achieving steroid-free clinical remission with fecal calprotectin <250 at 1 year.

Researchers identified several factors associated with increased risk of bowel damage progression, including edema, ulceration, contrast enhancement, diffusion-weighted hyperintensity, fat wrapping, bowel thickening (>3 mm), and enlarged lymph nodes (P < .01). Bowel thickness was the most sensitive marker of treatment response (P = .001). The C-score was derived using a formula incorporating bowel thickness, lymph nodes, and ulcers.

Transmural healing, defined by a C-score <0.5, and transmural response (50% or 25% decrease in C-score) were linked to lower risk of bowel damage progression in both retrospective and validation cohorts (P < .01). In the prospective cohort, achieving TH or TR after 12 weeks of antitumor necrosis factor therapy significantly increased the likelihood of steroid-free remission at 1 year.

The C-score is a validated, easy-to-use tool for assessing transmural healing and transmural response in CD patients, and both are associated with better clinical outcomes.

Reference
Buisson A, Junda J, Vignette J, et al. Development and validation of a score to assess transmural healing and response in patients with Crohn's disease. Clin Gastroenterol Hepatol. Published online June 20, 2024. doi:10.1016/j.cgh.2024.06.007