Intestinal barrier healing is superior to transmural healing to prevent disease progression in clinical remittent patients with inflammatory bowel disease

Orlemann T, Zimmermann D, Hübner H, Atreya R, Bodenschatz J, Noviello D, Vitali F, Strobel D, Janka RM, Uter W, Hartmann A, Neurath M, Rath T (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Journal of Crohns & Colitis Elsevier

Book Volume: 20

Article Number: jjaf232

Journal Issue: 1

DOI: 10.1093/ecco-jcc/jjaf232

Abstract

Background Achieving endoscopic remission is a key therapeutic goal in inflammatory bowel disease (IBD) that is associated with improved disease outcome. Transmural and intestinal barrier healing represent emerging targets, as they have similarly been associated with favourable disease behaviour. To date, no study has compared these novel end-points and their impact on avoiding deleterious disease outcome. Methods Clinically remittent IBD patients underwent ileocolonoscopy with assessment of intestinal barrier function by endomicroscopy. Transmural healing was assessed by magnetic resonance imaging or intestinal ultrasonography. Endoscopic and histologic disease activity were prospectively assessed along established scores. During subsequent follow-up (FU), patients were closely monitored for disease activity and major adverse outcomes (MAO): Disease flares, IBD-related hospitalization/surgery, initiation or escalation of systemic steroid, immunosuppressive or targeted advanced therapy. Results Eighty patients (47 Crohn’s disease [CD], 33 ulcerative colitis [UC]) were included. During a mean FU of 34 (CD) and 18 (UC) months, 72% of CD and 85% of UC patients experienced MAO. Intestinal barrier healing exhibited the highest accuracy for predicting MAO-free survival in UC and CD patients and outcompeted transmural healing for predicting the further disease course. Both barrier healing and transmural healing showed higher diagnostic accuracy in forecasting the future course of disease when compared to endoscopic and histologic remission. Conclusion Intestinal barrier healing is superior to transmural healing to prevent disease progression in clinical remittent IBD patients while both barrier and transmural healing showed superiority over endoscopic and histologic remission. Hence, barrier and transmural healing are emerging end-points potentially refining disease monitoring and outcome prediction.

Authors with CRIS profile

Till Orlemann Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Dana Zimmermann Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Hannah Hübner Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Raja Atreya Professur für Translationale Immunforschung bei chronisch entzündlichen Darmerkrankungen Julia Bodenschatz Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Francesco Vitali Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Deike Strobel Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Rolf Matthias Janka Institute of Radiology Wolfgang Uter Professur für Epidemiologie Arndt Hartmann Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie Markus Neurath Lehrstuhl für Innere Medizin I (Medizin 1) Timo Rath Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology

How to cite

APA:

Orlemann, T., Zimmermann, D., Hübner, H., Atreya, R., Bodenschatz, J., Noviello, D.,... Rath, T. (2026). Intestinal barrier healing is superior to transmural healing to prevent disease progression in clinical remittent patients with inflammatory bowel disease. Journal of Crohns & Colitis, 20(1). https://doi.org/10.1093/ecco-jcc/jjaf232

MLA:

Orlemann, Till, et al. "Intestinal barrier healing is superior to transmural healing to prevent disease progression in clinical remittent patients with inflammatory bowel disease." Journal of Crohns & Colitis 20.1 (2026).

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