scholarly journals P317 Key features of bowel ultrasonography in managing inflammatory bowel disease patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S312-S313
Author(s):  
A Les ◽  
R Iacob ◽  
R Costache ◽  
L Gheorghe ◽  
C Gheorghe
Keyword(s):  
Inflammatory Bowel Disease ◽  
Wall Thickness ◽  
Biological Markers ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Independent Predictor ◽  
Doppler Signal ◽  
Bowel Wall Thickness ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Abstract Background Bowel ultrasonography (BUS) is an accurate imaging method for detecting and monitoring inflammatory bowel disease (IBD) patients. This technique is recommended by current guidelines besides gold standard endoscopic assessment in managing IBD patients. Several BUS characteristics strongly correlate with biological markers of inflammation suggesting that these tests could be used in monitoring IBD patients but is yet unknown how these features predict the patient’s evolution. Methods Our study included 95 consecutive IBD patients (24 diagnosed with ulcerative colitis, 71 with Crohn’s disease) with both active and inactive disease at presentation. IBD diagnosis was established endoscopically and histologically. Patients with superimposed infection (viral or bacterial) and patients that had solely rectal involvement of the disease were excluded. BUS was conducted at baseline by one skilled examiner blinded to biological data. Biological markers were evaluated at baseline and all cases were prospectively followed-up for the need of therapy escalation during the next 6 months. The following BUS characteristics were registered in every patient: bowel wall thickness, alteration of wall structure, thickened mucosa or submucosa, presence of hyperechoic spots in the mucosal wall, irregularity of the external wall, Doppler signal, presence of mesenteric hypertrophy, presence of lymph nodes, and an overall assessment of the examination. No special preparation was needed before BUS. Results Of all the monitored sonographic features, the following characteristics correlated with the need of increasing treatment in the following 6 months: bowel wall thickness, altered structure of the wall, hypertrophic mucosa, Doppler signal, and the overall assessment of the examination (p < 0.001). The presence of the lymph nodes, hyperechoic spots in the mucosa, thickened submucosa and the irregularity of the external wall were not statistically significant correlated with the need for treatment escalation. The strongest correlation with the need for increasing treatment was documented for a mean bowel wall thickness > 5 mm and for Doppler signal presence in the bowel wall (p < 0.00001). In the multivariate analysis, Doppler signal presence was the only independent predictor for the need treatment escalation during a 6-month follow-up. Conclusion The most important sonographic features with an impact on therapeutic decision making in IBD patients are: bowel wall thickness, Doppler signal, altered stratification of the wall and mesenteric hypertrophy. In our analysis, the Doppler signal was the only independent predictor for the need for step-up therapy.

Monitoring Inflammatory Bowel Disease in Pregnancy Using Gastrointestinal Ultrasonography

2020 ◽  
Vol 14 (10) ◽  
pp. 1405-1412 ◽  
Author(s):  
Emma Flanagan ◽  
Emily K Wright ◽  
Jakob Begun ◽  
Robert V Bryant ◽  
Yoon-Kyo An ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Wall Thickness ◽  
Terminal Ileum ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Faecal Calprotectin ◽  
Bowel Wall Thickness ◽  
Inflammatory Bowel ◽  
In Pregnancy

Abstract Background and Aims Inflammatory bowel disease [IBD] affects women during their childbearing years. Gastrointestinal ultrasonography [GIUS] accurately identifies disease activity in non-pregnant patients with IBD. The utility of GIUS in pregnancy has not been established. We aimed to determine the feasibility and accuracy of GIUS in the assessment of IBD during pregnancy progression. Methods A multicentre observational study of women with IBD undergoing GIUS during pregnancy. Clinicians assessed the adequacy of bowel views and disease activity in four colonic segments and the terminal ileum. Location[s] in which views were impeded by the uterus were documented. GIUS disease activity [bowel wall thickness >3 mm] was compared with biochemical disease activity [faecal calprotectin >100 μg/g]. Results Ninety patients and 127 GIUS examinations were included [median gestation 19 weeks, range 4–33]. Adequate colonic views were obtained in 116/127 [91%] scans. Adequate ileal views were obtained in 62/67 [93%] scans <20 weeks and 30/51 [59%] scans at 20–26 weeks. There was a positive correlation between bowel wall thickness and calprotectin [r = 0.26, p = 0.03]. GIUS delivered a specificity of 83%, sensitivity of 74%, and negative predictive value of 90% compared with calprotectin. Conclusions GIUS is a feasible and accurate modality for monitoring IBD in pregnancy. Adequate GIUS views of the colon and terminal ileum can be obtained in the majority of patients up to 20 weeks of gestation. Beyond 20 weeks, GIUS provides good views of the colon but the terminal ileum becomes difficult to assess.

scholarly journals P400 Bowel ultrasonography, a non invasive easy-to-use method to predict the need to step-up therapy in inflammatory bowel disease patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S409-S409
Author(s):  
A Les ◽  
R Iacob ◽  
B Cotruta ◽  
R Saizu ◽  
L Gheorghe ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Bowel Wall ◽  
Univariate Analysis ◽  
Doppler Signal ◽  
Treat To Target ◽  
Treatment Intensification ◽  
Bowel Wall Thickness ◽  
Inflammatory Bowel ◽  
Bowel Ultrasound ◽  
Ultrasound Features

Abstract Background Inflammatory bowel diseases (IBD) are chronic conditions that require multiple endoscopic and imaging assessments. Recent guidelines recommend bowel ultrasonography (BUS) as a complimentary imaging technique to assess transmural and extraintestinal lesions. The aim of the present study was to evaluate the accuracy of BUS in predicting the need to step-up therapy in IBD patients. Methods 117 IBD patients were included in the study (28 diagnosed with ulcerative colitis, 89 with Crohn’s disease). Following bowel ultrasound features bowel ultrasound features have been investigated: bowel wall thickness, loss of wall stratification, presence of bowel wall Doppler signal, the presence of hyperechoic spots inside the bowel wall, the irregularity of the external layer of the wall, the presence of creeping fat (mesenteric hypertrophy), the presence of visible lymph nodes. Patients were followed up for the next 6 months and data regarding their therapy was noted. Results During follow-up, therapeutic step-up, or biological treatment intensification (study outcome) were considered in 49.5% of cases in our study group. In a univariate analysis all the studied bowel ultrasound features but not the disease phenotype were significantly associated with the outcome. In the multivariate analysis only mean bowel wall thickness (<0.0001) and the presence of bowel wall Doppler signal (0.007) were independent predictors. Using the logistic regression prediction model, a score to evaluate the need of IBD treatment intensification could be calculated - Bowel Ultrasound Score (BU Score). The AUROC of the new BU score as a predictor for treatment intensification at 6 months in patients with IBD is 0.92, with a sensitivity of 84% and a specificity of 89%, indicating a good clinical utility. For the same outcome, AUROC for CRP was 0.81 whereas for fecal calprotectin was 0.85. Conclusion As the “treat to target concept” is the currently accepted novel treatment paradigm, incorporating BUS in IBD patients monitoring (BU score) provides an easy-to-use and readily available tool to stratify patients in need for therapeutic intensification.

scholarly journals Serum N-Glycomic Biomarkers Predict Treatment Escalation in Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Archana Shubhakar ◽  
Bas C Jansen ◽  
Alex T. Adams ◽  
Karli R. Reiding ◽  
Nicholas T. Ventham ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
High Performance ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Predictive Capacity ◽  
Cox Proportional Hazard Models ◽  
Independent Replication ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Abstract A blood-based prognostic biomarker to guide clinical decision-making at diagnosis of inflammatory bowel disease (IBD) would be immensely helpful. We investigated a composite serum N-glycomic biomarker to predict future disease course in 244 newly diagnosed IBD patients. Forty-seven individual glycan peaks were analysed using ultra-high performance liquid chromatography identifying 105 glycoforms from which 24 derived glycan traits were calculated. Multivariable logistic regression was performed to determine associations of derived glycan traits with disease. Cox proportional hazard models were used to predict treatment escalation from first-line treatment to biologics or surgery (hazard ratio (HR) 25.9, p = 1.1×10− 12; 95% confidence interval (CI), 8.52–78.78). Application to an independent replication cohort of 54 IBD patients yielded a HR of 5.1 (p = 1.1×10− 5; 95% CI, 2.54–10.1). These data demonstrate the predictive capacity of serum N-glycan biomarkers and represent a step towards personalized medicine in IBD.

scholarly journals Quantitative contrast-enhanced ultrasound for monitoring vedolizumab therapy in inflammatory bowel disease patients: a pilot study

2018 ◽  
Vol 59 (10) ◽  
pp. 1149-1156 ◽  
Author(s):  
Ruediger S Goertz ◽  
Daniel Klett ◽  
Dane Wildner ◽  
Raja Atreya ◽  
Markus F Neurath ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Color Doppler ◽  
Response To Treatment ◽  
Clinical Activity ◽  
Contrast Enhanced Ultrasound ◽  
Software Analysis ◽  
Contrast Enhanced ◽  
Inflammatory Bowel

Background Microvascularization of the bowel wall can be visualized and quantified non-invasively by software-assisted analysis of derived time-intensity curves. Purpose To perform software-based quantification of bowel wall perfusion using quantitative contrast-enhanced ultrasound (CEUS) according to clinical response in patients with inflammatory bowel disease treated with vedolizumab. Material and Methods In a prospective study, in 18 out of 34 patients, high-frequency ultrasound of bowel wall thickness using color Doppler flow combined with CEUS was performed at baseline and after 14 weeks of treatment with vedolizumab. Clinical activity scores at week 14 were used to differentiate between responders and non-responders. CEUS parameters were calculated by software analysis of the video loops. Results Nine of 18 patients (11 with Crohn’s disease and seven with ulcerative colitis) showed response to treatment with vedolizumab. Overall, the responder group showed a significant decrease in the semi-quantitative color Doppler vascularization score. Amplitude-derived CEUS parameters of mural microvascularization such as peak enhancement or wash-in rate decreased in responders, in contrast with non-responders. Time-derived parameters remained stable or increased during treatment in all patients. Conclusion Analysis of bowel microvascularization by CEUS shows statistically significant changes in the wash-in-rate related to response of vedolizumab therapy.

scholarly journals Intestinal Microbiota Transplantation for Patients With Inflammatory Bowel Disease Prevents Recurrence of C. difficile Infections but Not Recurrence of Gastrointestinal Symptoms

2019 ◽  
Vol 26 (9) ◽  
pp. 1421-1422
Author(s):  
Lea Ann Chen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Intestinal Microbiota ◽  
Bowel Disease ◽  
Gastrointestinal Symptoms ◽  
Effective Therapy ◽  
Clostridioides Difficile ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Intestinal microbiota transplantation (IMT) is an effective therapy for recurrent Clostridioides difficile infections in patients with inflammatory bowel disease (IBD). However, further research is needed to understand the safety of this procedure, particularly given the frequency of gastrointestinal symptoms and of IBD treatment escalation after IMT.

scholarly journals Sarcopenia as an independent predictor of the surgical outcomes of patients with inflammatory bowel disease: a meta-analysis

Surgery Today ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 1138-1150 ◽  
Author(s):  
Adrienn Erős ◽  
Alexandra Soós ◽  
Péter Hegyi ◽  
Zsolt Szakács ◽  
Márton Benke ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Postoperative Complications ◽  
Early Detection ◽  
Confidence Interval ◽  
Bowel Disease ◽  
Surgical Outcomes ◽  
Independent Predictor ◽  
Meta Analysis ◽  
Random Effects Models ◽  
Inflammatory Bowel

Abstract Patients with inflammatory bowel disease (IBD) are at risk of sarcopenia, which is associated with poor clinical outcomes. We conducted this study to assess whether sarcopenia predicts the need for surgery and postoperative complications in patients with IBD. We performed a systematic search of four electronic databases, last updated in March, 2019. Data from studies comparing rates of surgery and postoperative complications in sarcopenic IBD patients versus non-sarcopenic IBD patients were pooled with the random-effects models. We calculated the odds ratios (OR) with a 95% confidence interval (CI). Ten studies with a collective total of 885 IBD patients were included in our meta-analysis. Although the analysis of raw data did not reveal significant differences between the two groups with respect to the rate of surgery and postoperative complications (OR = 1.826; 95% CI 0.913–3.654; p = 0.089 and OR = 3.265; 95% CI 0.575–18.557; p = 0.182, respectively), the analysis of adjusted data identified sarcopenia as an independent predictor for both of the undesirable outcomes (OR = 2.655; 95% CI 1.121–6.336; p = 0.027 and OR = 6.097; 95% CI 1.756–21.175; p = 0.004, respectively). Thus, early detection of sarcopenia in patients with IBD is important to prevent undesirable outcomes.

scholarly journals Whole Blood Profiling of T-cell-Derived microRNA Allows the Development of Prognostic models in Inflammatory Bowel Disease

2020 ◽  
Vol 14 (12) ◽  
pp. 1724-1733
Author(s):  
R Kalla ◽  
A T Adams ◽  
N T Ventham ◽  
N A Kennedy ◽  
R White ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
T Cells ◽  
T Cell ◽  
Bowel Disease ◽  
Whole Blood ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Prognostic Models ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Abstract Background MicroRNAs [miRNAs] are cell-specific small non-coding RNAs that can regulate gene expression and have been implicated in inflammatory bowel disease [IBD] pathogenesis. Here we define the cell-specific miRNA profiles and investigate its biomarker potential in IBD. Methods In a two-stage prospective multi-centre case control study, next generation sequencing was performed on a discovery cohort of immunomagnetically separated leukocytes from 32 patients (nine Crohn’s disease [CD], 14 ulcerative colitis [UC], eight healthy controls) and differentially expressed signals were validated in whole blood in 294 patients [97 UC, 98 CD, 98 non-IBD, 1 IBDU] using quantitative PCR. Correlations were analysed with phenotype, including need for early treatment escalation as a marker of progressive disease using Cox proportional hazards. Results In stage 1, each leukocyte subset [CD4+ and CD8+ T-cells and CD14+ monocytes] was analysed in IBD and controls. Three specific miRNAs differentiated IBD from controls in CD4+ T-cells, including miR-1307-3p [p = 0.01], miR-3615 [p = 0.02] and miR-4792 [p = 0.01]. In the extension cohort, in stage 2, miR-1307-3p was able to predict disease progression in IBD (hazard ratio [HR] 1.98, interquartile range [IQR]: 1.20–3.27; logrank p = 1.80 × 10–3), in particular CD [HR 2.81; IQR: 1.11–3.53, p = 6.50 × 10–4]. Using blood-based multimarker miRNA models, the estimated chance of escalation in CD was 83% if two or more criteria were met and 90% for UC if three or more criteria are met. Interpretation We have identified and validated unique CD4+ T-cell miRNAs that are differentially regulated in IBD. These miRNAs may be able to predict treatment escalation and have the potential for clinical translation; further prospective evaluation is now indicated.

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