Measurement of Fibrosis in Crohn's Disease Strictures with Imaging and Blood Biomarkers to Inform Clinical Decisions

2017 ◽  
Vol 35 (1-2) ◽  
pp. 32-37 ◽  
Author(s):  
Peter D.R. Higgins
Keyword(s):  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Matrix Protein ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Photoacoustic Imaging ◽  
Clinical Decision ◽  
Serum Biomarkers ◽  
Intestinal Fibrosis

Background: Distinguishing fibrosis from inflammation in an intestinal stricture in Crohn's disease is quite difficult. The absence of signs of inflammation on CT or MRI does not prove the absence of inflammation, as most strictures have a mix of fibrosis and inflammation. Identifying refractory fibrosis and distinguishing the patients who will respond to anti-inflammatory therapy from those who will require surgery are important clinical requirements, and several new technologies in imaging and serum biomarkers are being applied to this problem. Key Messages: Delayed gadolinium enhancement of a Crohn's disease stricture on MRI can reliably identify severe fibrosis, and may be helpful in deciding which patients will require surgery. However, this approach does not appear to be able to identify patients with mild or moderate fibrosis. New imaging technologies, including T2/magnetization transfer MRI, shear wave velocity ultrasound, and photoacoustic imaging, offer promising animal data that could prove to accurately assist clinical decision making. Glyoproteomics has identified hepatic growth factor alpha and cartilage oligomeric matrix protein as possible serum biomarkers to detect and measure intestinal fibrosis. The presence of upstream small bowel dilation >3.5 cm or a platelet/albumin ratio >150 helps in identifying Crohn's disease patients at high risk of stricture resection in the next 2 years. Conclusions: Imaging and biomarker technologies to measure intestinal fibrosis are rapidly evolving, and could soon provide valuable information for clinical decision making for patients with intestinal strictures from Crohn's disease

scholarly journals P418 Does capsule endoscopy impact clinical management in established Crohn’s Disease?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S423-S424
Author(s):  
A Elosua Gonzalez ◽  
M Rullan Iriarte ◽  
S Rubio Iturria ◽  
S Oquiñena Legaz ◽  
C Rodríguez Gutiérrez ◽  
...  
Keyword(s):  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Real Life ◽  
Clinical Decision ◽  
Mucosal Inflammation ◽  
Therapeutic Impact

Abstract Background Capsule endoscopy (SBCE) has developed a relevant role in different indications in patients with established Crohn’s Disease (CD). However, evaluation of its impact in clinical management in CD specific modification strategies has been scarce. The purpose of our study was to question therapeutic impact of SBCE in an 11-year real-life cohort of established CD patients. Methods Retrospective single center study including all consecutive patients with CD submitted to SBCE from January 2008 to December 2019. Small bowel patency was evaluated with patency capsule in selected patients. A conclusive procedure was defined as the one that allowed clinical decision-making. Mucosal inflammation was graded as mild (few aphtoid ulcers), moderate (multiple aphtoid ulcers/isolated deep ulcers) or severe (multiple deep ulcers/stenosis). Therapeutic impact was defined as a change in CD related treatment including escalation, de-escalation, dose adjustment or referral to surgery recommended based on SBCE results within the next 3 months after the SBCE. Patients were assigned to four groups regarding CE indication: staging, flare, post-op and remission (fig 1). Results From the 432 CE performed, 378 (87.5%) were conclusive and allowed clinical decision-making. SBCE results guided changes in 51.3% of patients: 199 (46.1%) with escalation and 23 (5.3%) with de-escalation of treatment. Active disease was present in 310 (71.8%) patients; 131 (30.3%) presented mild, 126 (29.2%) moderate and 53 (12.3%) severe activity. Disease activity demonstrated by SBCE correlated with therapeutic changes. With mild activity 24.1% increased therapy, whereas 77.8% and 84.9% increased therapy with moderate or severe disease, respectively (p<0.001). De-escalation was conducted in 12.8% patients with mucosal healing and 6.1% with mild disease but not in moderate or severe activity (p<0.001). Treatment before and after SBCE is shown in the table. Conclusion SBCE is a safe and useful tool when approaching established CD patients guiding therapeutic management in a real-life setting. Its positive impact does not limit to treatment escalation but also helps to de-escalate in patients who can benefit from it.

scholarly journals Mo1821 – The Utility of Monitr® Test as a Clinical Decision-Making tool in Crohn’s Disease

2019 ◽  
Vol 156 (6) ◽  
pp. S-850
Author(s):  
Hafiz Muhammad Sharjeel Arshad ◽  
Jigar Bhagatwala ◽  
Ayesha Cheema ◽  
Raiya Sarwar ◽  
Subbaramiah Sridhar ◽  
...  
Keyword(s):  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Tool

scholarly journals Impact of faecal calprotectin measurement on clinical decision-making in patients with Crohn’s disease and ulcerative colitis

PLoS ONE ◽  
2019 ◽  
Vol 14 (10) ◽  
pp. e0223893
Author(s):  
Anna Luisa Bathe ◽  
Eirini Mavropoulou ◽  
Nicolae-Catalin Mechie ◽  
Golo Petzold ◽  
Volker Ellenrieder ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Faecal Calprotectin

scholarly journals Clinic-based Point of Care Transabdominal Ultrasound for Monitoring Crohn’s Disease: Impact on Clinical Decision Making

2015 ◽  
Vol 9 (9) ◽  
pp. 795-801 ◽  
Author(s):  
Kerri Novak ◽  
Divine Tanyingoh ◽  
Frauke Petersen ◽  
Torsten Kucharzik ◽  
Remo Panaccione ◽  
...  
Keyword(s):  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Transabdominal Ultrasound ◽  
Disease Impact

scholarly journals A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Courtney Celian ◽  
Veronica Swanson ◽  
Maahi Shah ◽  
Caitlin Newman ◽  
Bridget Fowler-King ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Relative Advantage ◽  
Personal Attributes ◽  
Design Work ◽  
Cognitive Limitations ◽  
Knowledge And Beliefs ◽  
Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

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