P308 Utility of bowel ultrasound in diagnosing disease activity in Crohn’s disease: Indian experience

Abstract Background Objective goals are needed to guide patient management and assess treatment efficacy in patients with Crohn’s disease (CD). Bowel ultrasound (US) is a widely available, non-invasive and inexpensive technique increasingly being used in these patients. The use of bowel wall thickness (BWT) has been proved to be an accurate measure for assessing disease activity and response to therapy. Recent studies show a rapid improvement of BWT after 3-month of therapy. Our aim was to evaluate BWT variation after induction therapy with infliximab (IFX) in CD patients and correlate BWT with clinical and laboratory parameters. Methods Prospective cohort multicentre study including patients with active CD starting IFX therapy. Clinical disease activity was assessed using the Harvey–Bradshaw index (HBI). C-reactive protein (CRP) and faecal calprotectin (FC) were measured both at week 0 and after induction therapy (week 14), and infliximab trough levels (ITL) were measured at week 14. Bowel ultrasound was performed at week 0 and 14, BWT from the worst segment was selected for analysis. Abnormal BWT was defined has higher than 3mm in any bowel segment. Results We included 10 patients with CD (80% males; median age 29 (21–64) years). According to Montreal classification, most patients were A2 (7/10), had ileocolonic disease (L1 20%; L2 20%; L3 60%) and an inflammatory phenotype (B1 60%; B2 20% and B3 20%). Most patients were anti-TNF therapy naive (80%), and combination therapy was used in 80%. Before IFX (week 0) median HBI was 2 (IQR 1.75–5.25), CRP 1.10 mg/dl (IQR 0.65–3.50) and FC 802 μg/g (IQR 324–1336). The terminal ileum was the most affected segment identified by the USA (5/10), followed by ascending colon (2/10) descending colon (2/10) and sigmoid colon (1/10). Median BWT was 4.6 mm (IQR 3.6–6.4). After induction therapy (week 14), all patients were in clinical remission (HBI<5) except for one in whom IFX dose was increased to 10 mg/kg. Laboratory remission (CRP < 0.5 mg/dl and FC < 250 μg/g) was present in 50% of patients. US response (measured by a reduction in BWT of at least 0.5 mm) was observed in 70% of patients, with US remission (normalisation of BWT in the most affected segment) in 30%. At week 14, 70% of patient had ITL > 3 μg/ml. Median BWT at week 14 was higher in patients with ITL < 3 μg/ml (6.25 vs. 2.98 mm, p = 0.048). Conclusion The majority of our patients showed a US response (reduction in BWT) after 14 weeks of infliximab, suggesting that reduction in BWT could be an early marker of response to therapy. US evaluation after induction therapy can be a helpful tool to monitor disease activity and guide patient management in CD patients in our daily practice.

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S1221 Computed Tomography Enterography and Small Bowel Ultrasound in Assessing Ileal Crohn's Disease Activity

Gastroenterology ◽

10.1016/s0016-5085(08)60943-9 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-204

Author(s):

Alessandra Losco ◽

Chiara Trattenero ◽

Mirella Fraquelli ◽

Laura Virginia Forzenigo ◽

Sara Massironi ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Disease Activity ◽

Computed Tomography Enterography ◽

Crohn’S Disease Activity ◽

Bowel Ultrasound

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P273 Point-of-care bowel ultrasound for detecting ileocolonic inflammation in Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.402 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S288-S288

Author(s):

M Allocca ◽

G Fiorino ◽

F Furfaro ◽

A Zilli ◽

D Gilardi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Wall ◽

Point Of Care ◽

Multivariable Analysis ◽

Close Monitoring ◽

Reference Standard ◽

Bowel Ultrasound ◽

Active Disease

Abstract Background A ‘treat-to-target’ strategy with close monitoring of intestinal inflammation is recommended in Crohn’s disease (CD). Bowel ultrasound (US) is a non-invasive, point-of-care tool to assess CD activity and severity. However, no clear US-based parameters of activity have been identified by using magnetic resonance imaging (MRI) and colonoscopy together as a reference standard. We aimed to investigate whether US parameters could be able to measure CD activity and severity, comparing with the MaRIA and the SES-CD scores. Methods Ileal and/or colonic CD consecutive patients were prospectively assessed by CS, MRE and bowel US. Bowel wall thickening (mm), bowel wall-flow at colour Doppler (BWF: 0 absent; 1 present), bowel wall pattern (BWP: 0 normal; 1 hypoechogenic; 2 hyperchogenic; 3 lost), presence of mesenteric lymph nodes (0 absent; 1 present) and mesenteric hypertrophy (0 absent; 1 present), evaluated at bowel US were compared with CS+MRE findings as a reference standard. Activity was defined by an SES-CD score>2 and/or a MaRIA score>7). Results Sixty CD patients were prospectively enrolled (37% with ileal localisation, 15% with colonic localisation and 48% with ileocolonic localisation). Thirty patients had endoscopically active CD, 34 had radiologically active disease, 37 (62%) had active disease assessed at CS or MRE (SES-CD > 2 or MaRIA score >7 in at least one segment). BWT, presence of BWF, hypoechogenic or lost BWP significantly correlated with endoscopic and radiological activity (OR 4.51, 33.75, and 2.74 respectively, all p < 0.001). The multivariable analysis identified only BWT (per 1-mm increase, OR: 6.56, 95% CI 1.25–34.44, p = 0.026) as an independent predictor for disease activity. The cut-off value of 4.4 mm BWT was identified to distinguish active vs. non-active disease (AUROC 0.905, Sensitivity 81%, Specificity 96%). A significant correlation was found between BWT and MaRIA and SES-CD score (r = 0.768, 95% CI 0.662–0.868, p < 0.0001; r = 0.602, 95% CI 0.409–0.743; p < 0.0001; respectively). Conclusion Bowel US is able to assess and measure disease activity in ileocolonic CD in real-time. BWT correlated very well with the MaRIA score and the SES-CD score. Further studies are needed to confirm these findings and to demonstrate the role of point-of-care US in CD management.

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The Role of Bowel Ultrasound in Detecting Subclinical Inflammation in Pregnant Women with Crohn’s Disease

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwy062 ◽

2018 ◽

Vol 2 (4) ◽

pp. 153-160 ◽

Cited By ~ 3

Author(s):

Yvette Leung ◽

Hang Hock Shim ◽

Rune Wilkens ◽

Divine Tanyingoh ◽

Elnaz Ehteshami Afshar ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Pregnant Women ◽

Inactive Disease ◽

Subclinical Inflammation ◽

One Year ◽

Bowel Sonography ◽

Bowel Ultrasound ◽

Active Disease

Abstract Background and Aims Maintaining disease remission improves outcomes for pregnant women with Crohn’s disease (CD). As symptoms may correlate poorly with disease activity in the gravid state, we investigated the utility of bowel sonography during pregnancy to assess disease activity. Methods We conducted a prospective observational cohort study of pregnant women with CD undergoing bowel sonography between July 1, 2012, and December 1, 2016. Clinically active disease was defined using standardized clinical indices (Harvey Bradshaw Index >4 for active disease). Sonographic findings were graded as inactive (normal, mild) or active (moderate, severe) by expert radiologists. Results There were 91 pregnancies in 82 CD patients. Symptoms were present in 12 pregnancies; however, eight (67%) had sonographic findings of inactive disease, and escalation of therapy was not initiated. Conversely, sonographically active disease in seven asymptomatic pregnancies resulted in four women escalating therapy. The remaining three women declined escalation of therapy, one had a miscarriage, and the other two women had persistently active disease on sonography and endoscopy at one-year postpartum. Conclusions Bowel ultrasound may detect subclinical inflammation in asymptomatic pregnant women with CD and stratify CD activity in symptomatic patients. Therefore, bowel sonography should be considered as a useful adjunct for the assessment of the pregnant woman with Crohn’s disease.

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A127 ASSOCIATION OF TRANSABDOMINAL BOWEL ULTRASOUND FINDINGS AND SEVERITY OF INFLAMMATORY BOWEL DISEASE IN PEDIATRIC PATIENTS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.125 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 109-111

Author(s):

H Ma ◽

D Migliarese Isaac ◽

A Petrova ◽

D Parsons ◽

K Anna ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Disease Severity ◽

Activity Index ◽

Disease Activity Index ◽

Chi Square ◽

Mayo Score ◽

Ultrasound Findings ◽

Bowel Ultrasound

Abstract Background Previous research has shown that transabdominal bowel ultrasound (TABUS) can detect disease in inflammatory bowel disease (IBD) patients. Aims Our aim is to determine the parameters of bowel ultrasound findings that are associated with disease severity at time of diagnosis. Methods This prospective study was conducted at the Stollery Children’s Hospital in Edmonton, Alberta. Patients with suspect IBD were enrolled. Each patient underwent a baseline ultrasound, Physicians performed TABUS to visualize the small and large intestine (except rectum). Other investigations including blood work, MRI, and endoscopy. Disease severity in was categorised into mild, moderate and severe using the weighted pediatric Crohn’s disease activity index (wPCDAI), simple endoscopic score for CD (SES-CD), pediatric ulcerative colitis disease activity index (PUCAI), and Mayo score in UC. The severity of disease was compared to 7 ultrasound parameters (fat proliferation, hyperemia, bowel wall thickness (BWT), free intra- abdominal fluid, > 4 lymph nodes (LN) in an area, presence of stricture, and BW stratification. Data was analyzed using SPSS. Anova and Chi square were used to determine parameters for TABUS that were associated with disease severity, with p <0.05 considered significant. Results This prospective study was conducted at the Stollery Children’s Hospital in Edmonton, Alberta. Patients with suspect IBD were enrolled. Each patient underwent a baseline ultrasound, Physicians performed TABUS to visualize the small and large intestine (except rectum). Other investigations including blood work, MRI, and endoscopy. Disease severity in was categorised into mild, moderate and severe using the weighted pediatric Crohn’s disease activity index (wPCDAI), simple endoscopic score for CD (SES-CD), pediatric ulcerative colitis disease activity index (PUCAI), and Mayo score in UC. The severity of disease was compared to 7 ultrasound parameters (fat proliferation, hyperemia, bowel wall thickness (BWT), free intra- abdominal fluid, > 4 lymph nodes (LN) in an area, presence of stricture, and BW stratification. Data was analyzed using SPSS. Anova and Chi square were used to determine parameters for TABUS that were associated with disease severity, with p <0.05 considered significance. Conclusions Fat proliferation was found to be associated with severity of Crohn’s disease based on disease activity score while BWT was associated with endoscopic severity. Lack of association in UC is likely due to the low number of patients recruited. Funding Agencies WCHRI Capacity Grant

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P152 Bowel ultrasound as an early monitoring tool to assess disease activity in Crohn’s disease patients after induction therapy with infliximab

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.279 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S232-S232

Author(s):

B Morão ◽

C Nascimento ◽

C Frias Gomes ◽

T Gonçalves ◽

F Castro ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Induction Therapy ◽

Bowel Wall ◽

Intestinal Inflammation ◽

Clinical Laboratory ◽

Response To Therapy ◽

Laboratory Parameters ◽

Bowel Ultrasound

Abstract Background Bowel wall thickness (BWT) is an accurate sonographic parameter to assess disease activity in Crohn’s disease (CD). International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) was developed to allow a reproducible assessment of intestinal inflammation in CD using bowel ultrasound (IUS). Aim to assess BWT and IBUS-SAS variation after induction therapy with infliximab (IFX) and their correlation with clinical and laboratory parameters. Methods Prospective multicentre study including patients with active CD starting IFX. Harvey-Bradshaw index (HBI), C-reactive protein (CRP), faecal calprotectin (FC) and IUS were performed at week 0 (W0) and 14 (W14). IUS response and remission were defined as a reduction in BWT ≥25% and its normalization(≤3mm) in the most affected segment, respectively. IBUS-SAS was calculated using BWT, Doppler signal, bowel wall stratification (BWS) and inflammatory fat. Results We included 37 patients (62% males; median age 30 years, range 16–73). According to Montreal classification, most patients were A2 (70%), had ileocolonic disease (L3 57%) and an inflammatory phenotype (B1 60%); 41% had perianal disease. Most were anti-TNF therapy naive(84%), and combination therapy was used in 62%. Terminal ileum was the most affected segment identified by IUS (60%). Table 1 shows clinical, laboratory and sonographic parameters [median (IQR)]. At W14, 81% were in clinical remission, 43% in laboratorial remission (normal CRP and FC), 24% had IUS response and 11% had IUS remission. There was a significant reduction in HBI, CRP, FC and sonographic parameters (except for BWS) between W0 and W14. We found a fair to good correlation between BWT and HBI(r=0.363, p=0.03), CRP(r=0.391, p=0.02) and FC(r=0.373, p=0.03) at W14. IBUS-SAS had also a fair to good correlation with CRP(r=0.340, p=0.04) and FC(r=0.527, p=0.001) at W14. The area under the curve of IBUS-SAS for predicting clinical and laboratorial remission was 0.60; best-cut off 64.65 (sens. 57%; specif. 63%). Conclusion There was a significant reduction in sonographic parameters after 14 weeks of IFX and one quarter of our patients had an IUS response, suggesting that reduction in BWT could be an early marker of response to therapy. We found a good correlation between IUS and clinical and laboratory parameters at W14. IUS evaluation after induction therapy can be a helpful tool to monitor disease activity and guide CD patient management in our daily practice.

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Induction of β-defensin expression in Crohn's disease: Activity relate expression profile and subtype selective upregulation in gastrointestinal tissues

Gastroenterology ◽

10.1016/s0016-5085(01)81588-2 ◽

2001 ◽

Vol 120 (5) ◽

pp. A320-A320

Author(s):

A DEWEERTH ◽

M BLAEKER ◽

A REISSER ◽

M SCHULZ

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Expression Profile ◽

Crohn’S Disease Activity ◽

Subtype Selective

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P112 STUDY OF THE PROTEOMIC PROFILE IN PATIENTS WITH CROHN’S DISEASE, ITS CORRELATION WITH DIAGNOSIS AND DISEASE ACTIVITY

Gastroenterology ◽

10.1053/j.gastro.2017.11.158 ◽

2018 ◽

Vol 154 (1) ◽

pp. S58

Author(s):

Salah Badr El-Din ◽

Ezzat Ahmed ◽

Doaa Header ◽

Pacint Moez ◽

Mohamed Ibrahim

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Proteomic Profile

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Localization and Activity of Inflammatory Bowel Disease Using 111ln Leukocyte Imaging

Nuklearmedizin ◽

10.1055/s-0038-1629438 ◽

1988 ◽

Vol 27 (03) ◽

pp. 83-86 ◽

Cited By ~ 3

Author(s):

B. Briele ◽

F. Wolf ◽

H. J. Biersack ◽

F. F. Knapp ◽

A. Hotze

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Cell Uptake ◽

Disease Extent ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Leukocyte Imaging

A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of 111ln-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn’s disease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn’s disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

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