Abstract
Background/aimsThe small bowel is affected in more than half of patients with Crohn’s disease (CD) at the time of diagnosis, and small bowel involvement has a negative impact on the long-term outcome. Many patients reportedly have active lesions in the small intestine even in patients in clinical remission. This study was performed to compare findings of magnetic resonance enterography (MRE) and ileocolonoscopy.MethodsA single-center retrospective study was conducted in 50 patients (60 imaging series) with CD, for whom MRE was additionally performed during the bowel preparation for subsequent ileocolonoscopy. Endoscopic remission was defined as a Simple Endoscopic Score for CD (SES-CD) of <5. MRE remission was defined as a Magnetic Resonance Index of Activity (MaRIA) score of <50. The time to treatment escalation was assessed by the log-rank test.ResultsImportantly, 7 of 29 patients (24.1%) with endoscopic remission had a MaRIA score of ≥50. Both SES-CD and MaRIA correlated with the need for treatment escalation (P = 0.025, P = 0.009, respectively). MRE predicted the need for treatment escalation even in patients with endoscopic remission. Although no correlation was present between SES-CD and MaRIA score in patients with structuring/penetrating disease, or insufficient ileal insertion (<10cm), a high MaRIA score still correlated with the need for treatment escalation in stricturing or penetrating disease (P = 0.0306).ConclusionsThe MaRIA score predicts the need for treatment escalation even in patients with endoscopic remission, indicating that addition of MRE to conventional ileocolonoscopy alone can be a useful, noninvasive tool for monitoring CD especially in stricturing or penetrating disease.
Highlights
Crohn’s disease (CD) is a chronic inflammatory disease of the gastrointestinal tract that may flare and remit over time, and the number of affected patients is increasing
A single-center retrospective study was conducted in 50 patients (60 imaging series) with CD, for whom magnetic resonance enterography (MRE) was performed during the bowel preparation for subsequent ileocolonoscopy
7 of 29 patients (24.1%) with endoscopic remission had a Magnetic Resonance Index of Activity (MaRIA) score of 50. Both Simple Endoscopic Score for CD (SES-CD) and MaRIA correlated with the need for treatment escalation (P = 0.025, P = 0.009, respectively)
Summary
Crohn’s disease (CD) is a chronic inflammatory disease of the gastrointestinal tract that may flare and remit over time, and the number of affected patients is increasing. It is important to closely monitor the disease activity and achieve sustained remission and mucosal healing to prevent the progression of bowel damage. The small bowel is reportedly affected in 53% of patients with CD at the time of diagnosis (ileal and ileocolonic involvement in 27% and 26% of patients, respectively) according to the Montreal classification[1]. Small bowel involvement increases to 61% after 5 years[1]. The assessment of small intestinal lesions is important; one study showed that 43% to 60% of patients with established CD had suspected small bowel involvement[2]. Small bowel involvement negatively affects the long-term outcome of CD but is less associated with C-reactive protein and fecal calprotectin[3,4,5,6]. Ileal involvement in patients with CD is a significant risk factor[7, 8]
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