P405 Intestinal ultrasound measures are highly correlated with small bowel Lewis score among patients with active Crohn’s disease

Abstract

Abstract Background Small-bowel assessment is of prime importance among patients with Crohn’s disease (CD). While small-bowel capsule endoscopy (SBCE) evaluates the extent of mucosal inflammation, intestinal ultrasound (IUS) provides a complementary information with regards to transmural disease involvement. We aimed to examine the correlation between SBCE and IUS, among patients with active CD, as well as sensitivity to therapeutic response during follow-up. Methods Patients with active small-bowel CD, who have been started on biologics, were included. Patients were prospectively followed with fecal calprotectin (FC), SBCE and IUS at baseline and after 14 and 52 weeks. Lewis score (LS), Limberg score (LI) and terminal ileum bowel-wall thickness (TIBWT) were documented for each patient. Response to treatment was defined as a 25%-reduction compared to the baseline measure of FC, LS, LI and TIBWT, while FC<150μg/mg, LS<135, LI<2 and TIBWT<3 mm, were defined as biochemical, endoscopic and ultrasonographic remission, respectively (week 0→week 14/ week 14 →week 52). Baseline correlations were obtained using the Spearman's correlation. Comparison between correlations were assessed using the Fisher's Z-transformation. Fisher's exact-test was performed to evaluate the correlation between the examined response/remission outcomes. Results Seventy-one patients were included (median age: 26 (22-43) years, male-49%). The median time between SBCE and IUS procedures was 3 (0-25) days. Baseline LS was well correlated with both TIBWT (r=0.6, p<0.001) and LI (r=0.6, p<0.001). Ultrasonographic remission was significantly correlated with both biochemical remission (FC and TIBWT [p=0.012], FC and LI [p=0.024]) and endoscopic remission (LS and TIBWT [p=0.035], LS and LI [0.013]), [Figure 1]. The baseline correlation between FC and LS (r=0.490, p<0.001) was numerically but not significantly higher than FC and BWT (r=0.386, p=0.002) or FC and LI (r=0.224, p=0.080) [p=0.500 and p=0.110, respectively]. No significant correlation was observed between FC and LS /TIBWT/LI response to treatment (p=0.347 p=0.261, p=0.864, respectively), while there was a trend regarding TIBWT and LS response to treatment correlation (p=0.052). Conclusion IUS measures are highly correlated with SBCE LS among patients with active CD, and provide an accurate and reliable assessment of disease activity during follow-up. Therefore, IUS may serve as a feasible and noninvasive tool in the monitoring and management of patients with CD.