Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease
Discontinuation of anti–tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF...
Gespeichert in:
| Veröffentlicht in: | Clinical gastroenterology and hepatology 2023-03, Vol.21 (3), p.750-760.e4 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 760.e4 |
|---|---|
| container_issue | 3 |
| container_start_page | 750 |
| container_title | Clinical gastroenterology and hepatology |
| container_volume | 21 |
| creator | Mahmoud, Remi Savelkoul, Edo H.J. Mares, Wout Goetgebuer, Rogier Witteman, Ben J.M. de Koning, Daan B. van Tuyl, Sebastiaan A.C. Minderhoud, Itta Lutgens, Maurice W.M. D. Akol-Simsek, Dilek van Schaik, Fiona D.M. Fidder, Herma H. Jansen, Jeroen M. van Boeckel, Petra G.A. Mahmmod, Nofel Horjus-Talabur Horje, Carmen S. Römkens, Tessa E.H. Colombel, Jean-Frédéric Hoentjen, Frank Jharap, Bindia Oldenburg, Bas |
| description | Discontinuation of anti–tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing.
This was a multicenter, prospective study in adult patients with Crohn’s disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo |
| doi_str_mv | 10.1016/j.cgh.2022.08.024 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2709739546</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1542356522008205</els_id><sourcerecordid>2709739546</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-8e28dff07ce25d5c87e409bbdeea3a6ee7f249cd94d941ae3b7f375c5f68fb063</originalsourceid><addsrcrecordid>eNp9kM1q3DAUhUVpaP76ANkELbuxI8uWZdPVdPI3MCQQEroUsnSVaCpbrqRpmLevJzPJMnBBF_GdA_dD6KwgeUGK-mKVq-eXnBJKc9LkhFZf0FHBKppxXlRf93vJanaIjmNcEULbquXf0GFZE8ZYzY_QZu770UECfDVoH5UfrcK3IJ0dnvEi4lmMXlmZQOPfNr3gpX-FgB_AyTECfrDxD56ZNH3NhmSzx7vrN0wH-SodtgNeDMbJvpfJhw3-NYUdvrQRZIRTdGCki_B9_56gp-urx_lttry_Wcxny0yVbZ2yBmijjSFcAWWaqYZDRdqu0wCylDUAN7RqlW6raQoJZcdNyZlipm5MR-ryBP3Y9Y7B_11DTKK3UYFzcgC_joJy0vKyZdUWLXaoCj7GAEaMwfYybERBxNa4WInJuNgaF6QRk_Epc76vX3c96I_Eu-IJ-LkDYDryn4UgorIwKNA2gEpCe_tJ_X_xQJKc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2709739546</pqid></control><display><type>article</type><title>Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease</title><source>Elsevier ScienceDirect Journals</source><creator>Mahmoud, Remi ; Savelkoul, Edo H.J. ; Mares, Wout ; Goetgebuer, Rogier ; Witteman, Ben J.M. ; de Koning, Daan B. ; van Tuyl, Sebastiaan A.C. ; Minderhoud, Itta ; Lutgens, Maurice W.M. D. ; Akol-Simsek, Dilek ; van Schaik, Fiona D.M. ; Fidder, Herma H. ; Jansen, Jeroen M. ; van Boeckel, Petra G.A. ; Mahmmod, Nofel ; Horjus-Talabur Horje, Carmen S. ; Römkens, Tessa E.H. ; Colombel, Jean-Frédéric ; Hoentjen, Frank ; Jharap, Bindia ; Oldenburg, Bas</creator><creatorcontrib>Mahmoud, Remi ; Savelkoul, Edo H.J. ; Mares, Wout ; Goetgebuer, Rogier ; Witteman, Ben J.M. ; de Koning, Daan B. ; van Tuyl, Sebastiaan A.C. ; Minderhoud, Itta ; Lutgens, Maurice W.M. D. ; Akol-Simsek, Dilek ; van Schaik, Fiona D.M. ; Fidder, Herma H. ; Jansen, Jeroen M. ; van Boeckel, Petra G.A. ; Mahmmod, Nofel ; Horjus-Talabur Horje, Carmen S. ; Römkens, Tessa E.H. ; Colombel, Jean-Frédéric ; Hoentjen, Frank ; Jharap, Bindia ; Oldenburg, Bas ; Dutch Initiative on Crohn’s and Colitis (ICC) and the AWARE study group</creatorcontrib><description>Discontinuation of anti–tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing.
This was a multicenter, prospective study in adult patients with Crohn’s disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3–4) versus complete (Mayo 0/SES-CD 0–2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use.
Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6–2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43–7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01–0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months.
The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse.
[Display omitted]</description><identifier>ISSN: 1542-3565</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2022.08.024</identifier><identifier>PMID: 36055567</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Biologicals ; De-escalation ; Deep Remission ; Endoscopic Remission</subject><ispartof>Clinical gastroenterology and hepatology, 2023-03, Vol.21 (3), p.750-760.e4</ispartof><rights>2023 The Authors</rights><rights>Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-8e28dff07ce25d5c87e409bbdeea3a6ee7f249cd94d941ae3b7f375c5f68fb063</citedby><cites>FETCH-LOGICAL-c396t-8e28dff07ce25d5c87e409bbdeea3a6ee7f249cd94d941ae3b7f375c5f68fb063</cites><orcidid>0000-0002-4138-3058</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cgh.2022.08.024$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36055567$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mahmoud, Remi</creatorcontrib><creatorcontrib>Savelkoul, Edo H.J.</creatorcontrib><creatorcontrib>Mares, Wout</creatorcontrib><creatorcontrib>Goetgebuer, Rogier</creatorcontrib><creatorcontrib>Witteman, Ben J.M.</creatorcontrib><creatorcontrib>de Koning, Daan B.</creatorcontrib><creatorcontrib>van Tuyl, Sebastiaan A.C.</creatorcontrib><creatorcontrib>Minderhoud, Itta</creatorcontrib><creatorcontrib>Lutgens, Maurice W.M. D.</creatorcontrib><creatorcontrib>Akol-Simsek, Dilek</creatorcontrib><creatorcontrib>van Schaik, Fiona D.M.</creatorcontrib><creatorcontrib>Fidder, Herma H.</creatorcontrib><creatorcontrib>Jansen, Jeroen M.</creatorcontrib><creatorcontrib>van Boeckel, Petra G.A.</creatorcontrib><creatorcontrib>Mahmmod, Nofel</creatorcontrib><creatorcontrib>Horjus-Talabur Horje, Carmen S.</creatorcontrib><creatorcontrib>Römkens, Tessa E.H.</creatorcontrib><creatorcontrib>Colombel, Jean-Frédéric</creatorcontrib><creatorcontrib>Hoentjen, Frank</creatorcontrib><creatorcontrib>Jharap, Bindia</creatorcontrib><creatorcontrib>Oldenburg, Bas</creatorcontrib><creatorcontrib>Dutch Initiative on Crohn’s and Colitis (ICC) and the AWARE study group</creatorcontrib><title>Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease</title><title>Clinical gastroenterology and hepatology</title><addtitle>Clin Gastroenterol Hepatol</addtitle><description>Discontinuation of anti–tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing.
This was a multicenter, prospective study in adult patients with Crohn’s disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3–4) versus complete (Mayo 0/SES-CD 0–2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use.
Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6–2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43–7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01–0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months.
The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse.
[Display omitted]</description><subject>Biologicals</subject><subject>De-escalation</subject><subject>Deep Remission</subject><subject>Endoscopic Remission</subject><issn>1542-3565</issn><issn>1542-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kM1q3DAUhUVpaP76ANkELbuxI8uWZdPVdPI3MCQQEroUsnSVaCpbrqRpmLevJzPJMnBBF_GdA_dD6KwgeUGK-mKVq-eXnBJKc9LkhFZf0FHBKppxXlRf93vJanaIjmNcEULbquXf0GFZE8ZYzY_QZu770UECfDVoH5UfrcK3IJ0dnvEi4lmMXlmZQOPfNr3gpX-FgB_AyTECfrDxD56ZNH3NhmSzx7vrN0wH-SodtgNeDMbJvpfJhw3-NYUdvrQRZIRTdGCki_B9_56gp-urx_lttry_Wcxny0yVbZ2yBmijjSFcAWWaqYZDRdqu0wCylDUAN7RqlW6raQoJZcdNyZlipm5MR-ryBP3Y9Y7B_11DTKK3UYFzcgC_joJy0vKyZdUWLXaoCj7GAEaMwfYybERBxNa4WInJuNgaF6QRk_Epc76vX3c96I_Eu-IJ-LkDYDryn4UgorIwKNA2gEpCe_tJ_X_xQJKc</recordid><startdate>202303</startdate><enddate>202303</enddate><creator>Mahmoud, Remi</creator><creator>Savelkoul, Edo H.J.</creator><creator>Mares, Wout</creator><creator>Goetgebuer, Rogier</creator><creator>Witteman, Ben J.M.</creator><creator>de Koning, Daan B.</creator><creator>van Tuyl, Sebastiaan A.C.</creator><creator>Minderhoud, Itta</creator><creator>Lutgens, Maurice W.M. D.</creator><creator>Akol-Simsek, Dilek</creator><creator>van Schaik, Fiona D.M.</creator><creator>Fidder, Herma H.</creator><creator>Jansen, Jeroen M.</creator><creator>van Boeckel, Petra G.A.</creator><creator>Mahmmod, Nofel</creator><creator>Horjus-Talabur Horje, Carmen S.</creator><creator>Römkens, Tessa E.H.</creator><creator>Colombel, Jean-Frédéric</creator><creator>Hoentjen, Frank</creator><creator>Jharap, Bindia</creator><creator>Oldenburg, Bas</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4138-3058</orcidid></search><sort><creationdate>202303</creationdate><title>Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease</title><author>Mahmoud, Remi ; Savelkoul, Edo H.J. ; Mares, Wout ; Goetgebuer, Rogier ; Witteman, Ben J.M. ; de Koning, Daan B. ; van Tuyl, Sebastiaan A.C. ; Minderhoud, Itta ; Lutgens, Maurice W.M. D. ; Akol-Simsek, Dilek ; van Schaik, Fiona D.M. ; Fidder, Herma H. ; Jansen, Jeroen M. ; van Boeckel, Petra G.A. ; Mahmmod, Nofel ; Horjus-Talabur Horje, Carmen S. ; Römkens, Tessa E.H. ; Colombel, Jean-Frédéric ; Hoentjen, Frank ; Jharap, Bindia ; Oldenburg, Bas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-8e28dff07ce25d5c87e409bbdeea3a6ee7f249cd94d941ae3b7f375c5f68fb063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Biologicals</topic><topic>De-escalation</topic><topic>Deep Remission</topic><topic>Endoscopic Remission</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mahmoud, Remi</creatorcontrib><creatorcontrib>Savelkoul, Edo H.J.</creatorcontrib><creatorcontrib>Mares, Wout</creatorcontrib><creatorcontrib>Goetgebuer, Rogier</creatorcontrib><creatorcontrib>Witteman, Ben J.M.</creatorcontrib><creatorcontrib>de Koning, Daan B.</creatorcontrib><creatorcontrib>van Tuyl, Sebastiaan A.C.</creatorcontrib><creatorcontrib>Minderhoud, Itta</creatorcontrib><creatorcontrib>Lutgens, Maurice W.M. D.</creatorcontrib><creatorcontrib>Akol-Simsek, Dilek</creatorcontrib><creatorcontrib>van Schaik, Fiona D.M.</creatorcontrib><creatorcontrib>Fidder, Herma H.</creatorcontrib><creatorcontrib>Jansen, Jeroen M.</creatorcontrib><creatorcontrib>van Boeckel, Petra G.A.</creatorcontrib><creatorcontrib>Mahmmod, Nofel</creatorcontrib><creatorcontrib>Horjus-Talabur Horje, Carmen S.</creatorcontrib><creatorcontrib>Römkens, Tessa E.H.</creatorcontrib><creatorcontrib>Colombel, Jean-Frédéric</creatorcontrib><creatorcontrib>Hoentjen, Frank</creatorcontrib><creatorcontrib>Jharap, Bindia</creatorcontrib><creatorcontrib>Oldenburg, Bas</creatorcontrib><creatorcontrib>Dutch Initiative on Crohn’s and Colitis (ICC) and the AWARE study group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mahmoud, Remi</au><au>Savelkoul, Edo H.J.</au><au>Mares, Wout</au><au>Goetgebuer, Rogier</au><au>Witteman, Ben J.M.</au><au>de Koning, Daan B.</au><au>van Tuyl, Sebastiaan A.C.</au><au>Minderhoud, Itta</au><au>Lutgens, Maurice W.M. D.</au><au>Akol-Simsek, Dilek</au><au>van Schaik, Fiona D.M.</au><au>Fidder, Herma H.</au><au>Jansen, Jeroen M.</au><au>van Boeckel, Petra G.A.</au><au>Mahmmod, Nofel</au><au>Horjus-Talabur Horje, Carmen S.</au><au>Römkens, Tessa E.H.</au><au>Colombel, Jean-Frédéric</au><au>Hoentjen, Frank</au><au>Jharap, Bindia</au><au>Oldenburg, Bas</au><aucorp>Dutch Initiative on Crohn’s and Colitis (ICC) and the AWARE study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease</atitle><jtitle>Clinical gastroenterology and hepatology</jtitle><addtitle>Clin Gastroenterol Hepatol</addtitle><date>2023-03</date><risdate>2023</risdate><volume>21</volume><issue>3</issue><spage>750</spage><epage>760.e4</epage><pages>750-760.e4</pages><issn>1542-3565</issn><eissn>1542-7714</eissn><abstract>Discontinuation of anti–tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing.
This was a multicenter, prospective study in adult patients with Crohn’s disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3–4) versus complete (Mayo 0/SES-CD 0–2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use.
Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6–2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43–7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01–0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months.
The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36055567</pmid><doi>10.1016/j.cgh.2022.08.024</doi><orcidid>https://orcid.org/0000-0002-4138-3058</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1542-3565 |
| ispartof | Clinical gastroenterology and hepatology, 2023-03, Vol.21 (3), p.750-760.e4 |
| issn | 1542-3565 1542-7714 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2709739546 |
| source | Elsevier ScienceDirect Journals |
| subjects | Biologicals De-escalation Deep Remission Endoscopic Remission |
| title | Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T05%3A54%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Complete%20Endoscopic%20Healing%20Is%20Associated%20With%20Lower%20Relapse%20Risk%20After%20Anti-TNF%20Withdrawal%20in%20Inflammatory%20Bowel%20Disease&rft.jtitle=Clinical%20gastroenterology%20and%20hepatology&rft.au=Mahmoud,%20Remi&rft.aucorp=Dutch%20Initiative%20on%20Crohn%E2%80%99s%20and%20Colitis%20(ICC)%20and%20the%20AWARE%20study%20group&rft.date=2023-03&rft.volume=21&rft.issue=3&rft.spage=750&rft.epage=760.e4&rft.pages=750-760.e4&rft.issn=1542-3565&rft.eissn=1542-7714&rft_id=info:doi/10.1016/j.cgh.2022.08.024&rft_dat=%3Cproquest_cross%3E2709739546%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2709739546&rft_id=info:pmid/36055567&rft_els_id=S1542356522008205&rfr_iscdi=true |