A Simple Endoscopic Score for Crohn's Disease (SES‐CD) ≥ 7 Predicts Disease Progression

ABSTRACT Background Up to 30% of patients with Crohn's disease (CD) will experience a mild disease course. However, there is no consensus definition for mild CD. Aim To examine the Simple Endoscopic Score for Crohn's disease (SES‐CD) thresholds best associated with low likelihood of long‐term disease progression. Methods We conducted a multicentre retrospective cohort study at three tertiary care centres in United States and Europe. We analysed data from 177 surgery‐naïve patients with CD who had endoscopic assessment while not on immunosuppressive therapy. The primary outcome was disease progression (systemic steroids, biologic or immunomodulator therapy initiation; new stricturing or penetrating complications; or CD‐related hospitalisation or surgery). Univariable and multivariable Cox proportional hazards modelling identified predictors of the primary outcome at 2 and 5 years following endoscopy. Results Disease progression occurred in 23% and 35% of patients at years two and five, respectively. Endoscopic severity at enrolment independently predicted disease progression. Compared to those with an SES‐CD of 0, an SES‐CD ≥ 7 had a greater risk of progression at 2 years (HR 2.50, 95% CI 1.09–5.72) and 5 years (HR 2.89, 95% CI 1.41–5.91). SES‐CD > 7 remained independently predictive of disease progression among the 129 immunosuppression‐naïve patients (HR 5.65, 95% CI 1.49–21.52) and after excluding patients with prior penetrating disease (HR 2.32, 95% CI 1.00–5.45). Conclusions SES‐CD ≥ 7 predicts disease progression in mild CD. A score ≤ 6 may help identify patients less likely to progress and be part of the definition of mild CD.