CLE-Confirmed Intestinal Barrier Healing More Accurately Predicts IBD Outcomes

Intestinal barrier healing can help predict the disease course in IBD patients with clinical remission.

Confocal laser endomicroscopy (CLE) imaging predicts long-term disease outcomes more accurately than endoscopic- and histologic-confirmed remission in patients with inflammatory bowel diseases (IBD), according to study findings published in Gastroenterology.

CLE imaging uses high-resolution technology to visualize the subsurface intestinal mucosa in real time during ongoing endoscopy, enabling the functional assessment of intestinal barrier integrity and healing.

Researchers conducted a prospective, observational study (ERIca) at an outpatient IBD department comparing the potential of intestinal barrier healing vs endoscopic and histologic remission to predict long-term IBD disease outcomes in 181 patients with IBD (Crohn disease [CD], n=100; ulcerative colitis [UC], n=81).

The follow-up period lasted an average of 35 months for patients with CD and 25 months for patients with UC. During this time, 73% of patients with CD and 69% of patients with UC experienced at least 1 major adverse outcome.

CLE-based dynamic monitoring of the intestinal barrier during routine ileocolonscopy might be a helpful tool in clinical practice for risk-stratifying IBD patients and prediction of complicated disease behavior.

Major adverse outcomes consisted of disease flares, IBD-related hospitalizations or surgeries, and/or initiation or dose escalation of immunosuppressants, systemic steroids, small molecules, or biological therapies.

Researchers found that patients with IBD with endoscopically confirmed disease remission were significantly more likely to survive without major adverse outcomes than those with endoscopically active disease. Histologic remission predicted lack of adverse outcomes only in patients with UC, not CD.

Intestinal barrier healing confirmed by CLE imaging predicted survival without major adverse outcomes better than endoscopic or histologic remission in patients with CD or UC. Endoscopic and histologic remission predicted future IBD-related major adverse outcomes with 70.4% and 66.7% accuracy, respectively. In contrast, intestinal barrier healing using CLE imaging predicted long-term IBD disease behavior with 85% accuracy.

“Our results show…that barrier healing is highly predictive of the further course of disease in clinically remittent IBD patients and that the predictive capabilities of barrier function might well exceed established or emerging parameters such as endoscopic and histologic remission,” the study authors wrote. “CLE-based dynamic monitoring of the intestinal barrier during routine ileocolonscopy might be a helpful tool in clinical practice for risk-stratifying IBD patients and prediction of complicated disease behavior.”

Study limitations include lack of generalizability to other facilities that lack expertise in IBD care and interpretation of difficult imaging, lack of widespread use of probe-based CLE imaging outside of expert IBD centers, and lack of allowance for multiple comparisons in this exploratory approach.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Rath T, Atreya R, Bodenschatz J, et al. Intestinal barrier healing is superior to endoscopic and histologic remission for predicting major adverse outcomes in IBD: the prospective ERIca trial. Gastroenterology. Published online October 21, 2022. doi:10.1053/j.gastro.2022.10.014