Sa1210 Bowel Ultrasound Is Useful in Crohn's Disease Monitoring: Preliminary Results From the Trust Study in Germany

Abstract

Background: MR enterography (MRE) has been developed to detect intestinal lesions in patients with Crohn's disease (CD) without radiation exposure. However, there has been few study to assess the usefulness of MRE in patients who are treated with biologics. The aim of this study was to prospectively evaluate whether MRE could detect any CD lesions in patients with secondary loss of responsiveness for biologics.We also assessed the usefulness of MRE in predicting prognosis of CD patients who are treated with biologics. Methods: MRE were conducted in 36 patients with established CD who are treated with biologics (IFX 29, ADA 7). All patients used biologics at least for >12 months. At the enrollment into the study, clinical symptoms were recorded within 7 days before the procedures of MRE and Crohn's Disease Activity Index (CDAI) was calculated. Clinical remission was defined as CDAI ≤150, and loss of responsiveness (LOR) was defined as CDAI>150 at the entries. To assess the prognosis of CD, clinical characteristics and outcome after MRE for at least 6 months were collected. Clinical relapse was defined that 1) medical treatments were altered due to abdominal symptoms for CD, 2) CDAI>175, or 3) disease related hospitalization was required. Diagnostic ability of MRE was assessed in patients with clinical remission (n=23) and LOR (n=13). Cumulative non-relapse rate was calculated using Kaplan-Meier survival analysis and compared among groups using log-rank test. Results: 1) CD lesions on MRE were found in all patients with LOR (13/13). Inflammatory lesions (markedly increased contrast uptake, wall thickening), small intestinal strictures, and intestinal fistulas were detected in 100%, 69%, and 23% of patients with LOR, respectively. Interestingly, 15 (65%) of 23 patients with clinical remission had also CD lesions on MRE. 2) Among 23 patients with clinical remission, relapse rate was significantly higher (p=0.02) in patients with CD lesion on MRE (8/15, 53%) than that in patients who did not have any lesions on MRE (0/ 8, 0%) over a mean follow-up of 11 months. Log-rank test also demonstrated that the absence of lesion by MREC significantly prolonged the duration to clinical recurrence (p= 0.03) whereas the duration to clinical recurrence was not significantly difference in patients with normal CRP level than those in patients with higher CRP levels (p=0.11). Conclusions: MRE is useful for assessment of CD lesions and strictures in patients with secondary loss of responsiveness for biologics. MRE might predict clinical recurrences even in patients with clinical remission who are treated with biologics.