Endoscopic Healing Index Shows Limited Utility for Identifying CD Remission

A real-world analysis found the Endoscopic Healing Index (EHI) had poor predictive value for identifying the absence of active inflammation in patients with Crohn disease (CD), researchers reported in Digestive Diseases and Sciences.

Noting its “limited utility in confirming deep remission,” study corresponding author David T. Rubin, MD, and coauthors from the University of Chicago Medicine, Chicago, Illinois, advised the EHI “should be used with another objective modality.”

The retrospective study included 55 patients with CD who were treated and followed at the University of Chicago Medicine Inflammatory Bowel Disease Center. As part of routine clinical care, patients received EHI testing—an analysis of blood-based biomarkers—to assess mucosal healing. Researchers compared EHI results with results obtained from radiological imaging or endoscopy performed within 3 months of the EHI assessment to gauge the effectiveness of EHI as a disease activity predictor.

Among 8 patients with evidence of objective inflammation, 4 patients scored below 20 on the EHI, according to the study. At a score cutoff of 20 or less, the EHI had 89% sensitivity and 23.5% specificity for predicting no evidence of objective inflammation with an area under the receiver operating characteristic curve of 0.69, researchers reported. The score’s negative predictive value was 50%, and its positive predictive value was 72.3%.

At a score cutoff of 30 or less, the EHI could classify patients as having, or not having, objective evidence of inflammation more often than fecal calprotectin, the study found. EHI correctly classified inflammation 89% of the time, compared with 64% for fecal calprotectin.

Reference

Cohen NA, Choden T, Dyer EC, Garcia NM, Choi NK, Rubin DT. Utility of the Endoscopic Healing Index in identifying active inflammation in patients with Crohn's disease: real world data from a tertiary center. Dig Dis Sci. 2024;69(8):2955-2960. doi:10.1007/s10620-024-08492-9