Extraintestinal Manifestations Of Crohn Research Articles

The impact of crohn's disease on patients undergoing total knee arthroplasty.

The knee joint remains the most affected joint in extra-intestinal manifestations of Crohn's disease (CD). Given the increasing prevalence of CD and overall demand for total knee arthroplasty (TKA), it is likely that an increasing number of patients with CD will require TKA. The purpose of this study was to assess the inpatient postoperative complication in patients with CD undergoing TKA. We queried the Nationwide Inpatient Sample (NIS) database between the years of 2016 to 2019, including a total of 558,371 patients who underwent primary TKA. Among these, 1461 were in the CD group and 556,910 were in the non-CD group (controls). Data pertaining to demographics, length of stay (LOS), total healthcare cost, mortality, and in-hospital complications (blood loss anemia, blood transfusion, periprosthetic infection, periprosthetic dislocation, periprosthetic mechanical complication, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, superficial/deep surgical site infection, and wound dehiscence) were compared between the two groups. Patients diagnosed with CD had higher postoperative complications such as blood loss anemia (OR: 1.22, 95% CI: 1.07-1.39, p = 0.004), periprosthetic infection (OR: 1.80, 95% CI: 1.23-2.63, p = 0.006), and the need for blood transfusion (OR: 1.447, 95% CI: 1.01-2.06, p = 0.044) in comparison to the control group. In-hospital mortality and acute renal failure were similar in both groups. The CD group had a significantly prolonged LOS (2.54 vs. 2.35 days, p < 0.001). No statistically significant difference was noted concerning in-hospital charges between the two groups. CD patients undergoing TKA experienced increased LOS and postoperative complications. However, these complications were minor and did not affect total hospital cost. Further prospective cohort studies could build upon the findings described to continue to maximize outcomes in CD patients undergoing TKA, which might extend to other cohorts.

A rare occurrence of myocarditis with acute heart failure as an extraintestinal manifestation of Crohn&amp;rsquo;s disease in a young male

Crohn’s disease (CD) is an idiopathic inflammatory bowel disorder, which can be associated with various extraintestinal manifestations. Cardiac and pulmonary manifestations of CD are rare with only a few cases being reported. Myocarditis is an unusual and rare extraintestinal manifestation of CD. Only a few case reports associating CD with the above manifestation are found in the literature. Here, we report a case of an 18-year-old man diagnosed with CD for two years, on optimum treatment, presenting with the symptoms of myocarditis with acute heart failure, as extraintestinal manifestations in the absence of bowel symptoms, while being negative for infective and non infective aetiological screening. This case highlights the importance of knowing the rare extraintestinal manifestations of CD, which will ultimately guide the treating physicians.

Ophthalmological and extraintestinal manifestations of Crohn's disease

Ophthalmological and extraintestinal manifestations of Crohn's disease

C1 (Clinical Case) Case Presentation: Acute Genital Ulceration in a 15-Year-Old Girl

Abstract Introduction/Background Genital ulceration may occur in various conditions, and requires a systematic approach to its diagnosis. This should include consideration of both infectious and non-infectious etiologies. The most common causes of genital ulceration are herpes simplex virus (HSV) types 1 and 2 and syphilis (Treponema pallidum). Genital HSV may be asymptomatic or painful, and may present with inguinal lymphadenopathy, and fever. Primary syphilis may escape recognition as it presents with a single, painless, well-demarcated “chancre” that heals spontaneously in 3-6 weeks. Non-infectious etiologies of genital ulceration can include cutaneous drug reactions, and mechanical or chemical trauma. Granulomatous genital inflammation can be an extra-intestinal manifestation of Crohn’s disease characterized by pathognomonic “knife-cut” vulvar ulcers. This report presents a case of Lipschütz’s ulceration, or reactive non-sexually-acquired genital ulceration, as an under-recognized cause of genital ulcers in children. Case Description A previously healthy 15-year-old female presented to the emergency department with six days of daily fevers, and 72 hours of non-bloody diarrhea that had self-resolved. In addition, she complained of nausea and a headache. Notably, in the last day, she had developed labial swelling, perianal pruritus, and vaginal burning. On history, her last menstrual period was one week ago, and she was not sexually active. It was noted that she had consumed Kinder-SurpriseTM eggs in the last week, which had been recently recalled for Salmonella contamination. Pelvic exam initially showed multiple hemorrhagic vesicles involving the labia minora (Fig. 1A). On day one of admission, she developed two symmetric, well-delimited ulcers at the 5 o’clock and 7 o’clock positions on the labia minora, each 12 mm x 5 mm in size (Fig. 1B). By the second day of admission, she had dysuria requiring catheterizing. HSV, chlamydia and gonorrhea were not detected on vaginal swabs, and serologic testing for syphilis was negative. Salmonella montevideo was detected on her blood cultures and she was started on intravenous antibiotics. Her vulvar ulcers improved with a conservative regimen of local hygiene, wound care, and pain control. The final diagnosis was of Lipschütz’s ulceration (LU). Discussion LU is characterized by the sudden onset of necrotic and painful genital ulcers, and typically occurs in young (&amp;lt; 20 years old), sexually inactive females who have no history of genital ulcers, and were not previously affected by a chronic inflammatory condition. In LU, there are usually 1-3 lesions that are large (&amp;gt;10 mm), shallow and well-delimited. These tend to occur on the medial aspects of the labia minora and vestibule and have a symmetric “kissing” distribution on opposing surfaces. Voiding disorders, aphthous ulcers and enlarged inguinal lymph nodes have also been reported in LU. The pathophysiology of LU is not well understood. It often occurs concomitantly with an infectious disease and develops before its resolution. LU is most associated with Epstein-Barr virus, but has also been described with cytomegalovirus, mycoplasma species, Toxoplasma gondii, and influenza A and B. LU is self-limited and generally resolves without recurrence or long-term sequelae within 3 weeks. For analgesia, topical lidocaine is recommended, especially 5-10 minutes before micturition. Sitz baths, application of a bland barrier cream prior to and after voiding, avoidance of pads and underwear, and maintenance of good hydration to minimize irritation by concentrated urine also constitute important components of supportive care for LU. Conclusion Lipschütz’s ulcers are poorly understood and therefore under-diagnosed, or mis-diagnosed as herpes simplex infection, in which case they are treated with acyclovir without benefit. Identification of an etiologic trigger, such as a viral or bacterial infection, can aid in their appropriate detection. To date, there is one other reported case of LU associated with salmonella. This case report aims to describe LU as an uncommon but important entity in the paediatric population. Images

S2743 Mesalamine-Induced Interstitial Lung Disease in a Crohn’s Patient With COVID-19

Introduction: Extraintestinal manifestations of Crohn’s disease (CD) generally correlate to the disease activity and may be seen in 1 of 4 patients with CD. Though the prevalence of bronchopulmonary manifestations in CD is 0.4%, subclinical pulmonary changes may be seen in up to half of adults with CD, with involvement of the tracheobronchial tree, lung parenchyma or the pleura. Case Description/Methods: A 61-year-old man, with a history of CD diagnosed 2 years ago, currently in remission with mesalamine, was admitted to the ICU with acute hypoxic respiratory failure due to COVID-19. Inflammatory markers were elevated and he needed high-flow nasal cannula. He was started on a 5-day course of dexamethasone. By HOD-9 O2 requirement and inflammatory markers had trended down. However, around HOD-10 his O2 requirement increased to 6-10 L at rest. CT-chest showed peripherally distributed ground-glass opacities and superimposed early diffuse fibrotic lung changes. Superadded bacterial infection was ruled out. Mesalamine was discontinued and the patient was started on a course of iv methylprednisolone, after which oxygen requirements dramatically declined. He was discharged on HOD 24 with 2L O2 at rest and 4L on ambulation and a prednisone taper. Chest x-ray in 8 weeks showed improving infiltrates. On follow-up 5 months later, he was not on O2 anymore and was doing well. Discussion: Latent interstitial pulmonary involvement is seen in around 20%-55% of patients with IBD, with the most common manifestation being drug-induced lung disease, due to sulfasalazine, mesalamine, methotrexate, or anti-TNF agents. Pulmonary function tests can help in early identification of lung injury since respiratory involvement is latent many times. Onset of drug reaction can occur from 5 days to 44 months after initiation of mesalamine therapy and has been reported in the form of eosinophilic pneumonia, organizing pneumonia, nonspecific interstitial pneumonia and hypersensitivity pneumonitis. The absence of other extra-intestinal manifestations, and the remission of CD itself, can be helpful in excluding other pulmonary manifestations of CD from drug-induced lung disease. Discontinuation of the causative drug, along with a course of steroids, can help in reversing the symptoms. Though the differential of mesalamine-induced lung injury, cannot be confirmed nor excluded here, this patient probably had underlying lung pathology from his CD or its treatment, making his recovery from COVID-19 more complicated (Figure).Figure 1.: A: Portable Chest X-ray showing multifocal pneumonia, low lung volumes with bilateral patchy airspace disease; B, C: CT-Chest showing peripherally distributed ground-glass opacities, distributed in upper and lower lobes. There were superimposed early diffuse lung fibrotic changes, without any evidence of pulmonary thromboembolism; D: CT Chest, 5 months post-discharge, showing improvement in opacities.

S2757 Eye-BD—A Rare Case of Orbital Myositis as an Extra-intestinal Manifestation of Crohn’s Disease

Introduction: Crohn’s Disease (CD) is often associated with a diverse array of extra-intestinal manifestations (EIMs). The estimated prevalence of EIMs in patients with CD is 25-70%. The estimated prevalence of ocular manifestations in patients with CD is 3.5-6.8%. Orbital myositis (OM), characterized by inflammation of the extraocular muscles, is a rare ocular EIM associated with CD. Case Description/Methods: A 22-year-old female with CD on ustekinumab for maintenance therapy in remission presented with three days of right eye swelling and pain with extraocular movements. CT of the orbits reported minimal pre-septal tissue swelling, without evidence of orbital cellulitis. She was started on NSAIDs. A week later, the patient presented to the Ophthalmology clinic with resolution of her right eye symptoms but with new, similar symptoms in her left eye, including diplopia, restriction of lateral and medial gaze, and chemosis of the lateral conjunctiva. She denied symptoms concerning for a Crohn’s flare or other EIMs. The initial CT of the orbits was reviewed, and an addendum was made, reporting subtle enlargements of multiple extra-ocular muscles in the right orbit. She was diagnosed with bilateral OM. Infectious, endocrine, and autoimmune work-up was performed which were unrevealing and her OM was likely an EIM of her CD. She was started on prednisone 40 mg daily, which resulted in complete resolution of her symptoms at one-week follow-up. She was kept on ustekinumab maintenance therapy as she remained in clinical remission without evidence of other EIMs and completed her steroid taper without further complication. The patient was informed of the high recurrence rate of CD-associated OM and close follow-up was arranged. (Figure) Discussion: Overall, our patient’s OM was a likely EIM of her CD, as further laboratory work-up for commonly implicated etiologies to include thyroid disease, vasculitides, sarcoidosis, and IgG4-related disease was all negative. This case illustrates a rare EIM of CD in a patient believed to be in clinical remission, emphasizing the point that certain EIMs may occur independently of gastrointestinal luminal disease activity. Given that a high index of suspicion was necessary to reach the diagnosis given the subtle exam and imaging findings, this case also reiterates the importance of timely diagnosis and early management to minimize morbidity risk, which can be best accomplished through multidisciplinary coordination among subspecialty providers.Figure 1.: Orbital CT, Coronal- Asymmetric enlargement of the medial rectus in the RT orbit.

Ustekinumab in the Treatment of Erythema Nodosum with Underlying Crohn’s Disease: A Case Report

Erythema nodosum (EN) is a septal panniculitis characterized by raised, tender, red or purple lesions with a diameter of 1-5 cm. It is commonly treated with corticosteroids and can be an extra-intestinal manifestation of Crohn’s disease (CD). CD can be treated with ustekinumab, a monoclonal antibody that targets the p-40 subunit of the interleukin-12 (IL-12) and interleukin-23 (IL-23). A 78-year-old woman with erythema nodosum and Crohn’s disease presented with multiple erythematous nodules, which had been recurring on both of her legs for decades. The patient had failed many traditional EN treatments and was prescribed off-label ustekinumab, resulting in resolution of EN. This finding suggests that ustekinumab may be a potential treatment for EN in patients who also have CD.

Myopericarditis as an Extra-Intestinal Manifestation of Crohn’s Disease: A Case Report

Introduction: Myopericarditis is an uncommon manifestation of Crohn’s disease. Interestingly enough, it can present in a patient without any acute bowel symptoms. Case Presentation: A 21-year-old male with a medical history of Crohn’s disease and eosinophilic esophagitis presented to the hospital with chest pain and fever. Blood work revealed elevated troponin, C-reactive protein, and sedimentation rate levels. Electrocardiogram (EKG) showed diffuse ST elevation in all leads. Transthoracic echocardiogram (TTE) demonstrated a small pericardial effusion without valvular abnormalities. The patient was diagnosed with myopericarditis. Extensive etiological workup was negative, in the absence of other explanations, it was attributed to his Crohn’s disease. The patient was started on colchicine and ibuprofen. Out-patient follow-up revealed resolution of symptoms. Conclusion: This case reports the rare occurrence of myopericarditis and Crohn’s disease. Inflammatory bowel disease as a cause of myopericarditis has been reported in some cases within the literature; however, there is no definitive mechanism known.

Removal of Large Urinary Stone Using Percutaneous Nephrolithotomy in a Patient with Crohn’s Disease

&lt;p&gt;Extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD) is approximately 36%. Of genitourinary complications as an EIM of Crohn’s disease (CD), nephrolithiasis is the most common urinary complication in patients with CD. CD patients have been shown to have decreased urinary volume, pH, magnesium, and excretion of citrate, all of which are significant risk factors for nephrolithiasis. Genitourinary complications often occur in case of a severe longstanding disease and are associated with, the activity of bowel disease, especially in those who have undergone bowel surgery. As uncontrolled nephrolithiasis could impair renal function as well as adversely affect quality of life, proper monitoring, early detection, and prevention of the occurrence of urologic complications in CD is crucial. Few data are available about urolithiasis in patients with CD. Herein we report a case of a successful removal of a 2.7 cm calcium oxalate stone using percutaneous nephrolithotomy from a patient with long-standing CD with a previous surgery for small intestinal and colonic stricture.&lt;/p&gt;

ПОРАЖЕНИЕ РЕСПИРАТОРНОГО ТРАКТА ПРИ БОЛЕЗНИ КРОНА У РЕБЕНКА 6 ЛЕТ

The article is devoted to rare extraintestinal manifestations of Crohn's disease (CD) in children, primarily to the respiratory tract. A review of the literature on this problem in children's practice is presented. On the example of clinical case, data on the classification, pathogenesis, clinical picture, diagnosis, differential diagnosis and treatment of CD with respiratory tract damage in a young child are summarized.

Genital and Intertriginous Rashes Refractory to Antimicrobial Treatments: Have You Thought about Crohn’s Disease?

Crohn's disease is an inflammatory bowel disease that can have multiple extraintestinal manifestations and can develop prior to, following, or simultaneously with gastrointestinal tract involvement (Aberumand et al. (2017), Georgious et al. (2006), Larsen et al. (2010), Levine and Burakoff (2011), Louis et al. (2018)). This report examines the case of a 16-year-old male with a rash of the genital, intergluteal, and inguinal regions refractory to antimicrobial treatments suspicious for an extraintestinal manifestation of Crohn's disease. The patient was diagnosed with inflammatory, nonfistulizing colonic Crohn's disease following presentation with gastrointestinal symptoms including abdominal pain and bloody stools 6 months after the onset of the rash. The genital lesions resolved after starting treatment for Crohn's disease with adalimumab.

The impact of ustekinumab on extraintestinal manifestations of Crohn's disease: A post hoc analysis of the UNITI studies.

SummaryThis post hoc analysis of the UNITI studies found ustekinumab (UST) did not significantly improve overall extraintestinal manifestations (EIMs) of Crohn's disease compared to placebo‐treated patients at weeks 6 and 52.Background and AimsThe UNITI trials demonstrated that UST was effective in inducing and maintaining clinical remission in Crohn's disease (CD). However, limited data exists regarding its effectiveness for treatment of EIMs. This post hoc analysis evaluated the efficacy of UST in treatment of EIMs.MethodsData from UNITI‐1/2 and IM‐UNITI (NCT01369329, NCT01369342, NCT01369355) were obtained from the Yale Open Data Access Project (2019‐4104). Nine hundred and fourty‐one patients eligible for UST induction and 263 patients eligible for maintenance UST were included. The primary outcome of interest was EIM resolution at Week 6 in UST and placebo‐treated patients using the chi‐square test. EIM resolution at Week 52 was also assessed. McNemar's test was used to compare the proportion of patients who reported active EIMs at weeks 6 and 52 versus baseline.ResultsFrom 941 UST‐treated patients in UNITI‐1/2, 504 had 527 EIMs at baseline. Overall, there was no significant difference in EIM resolution observed in UST‐treated patients (186/504, 36.9%) compared to placebo (90/230, 39.1%; p = 0.564) at Week 6. Patients treated with continuous UST (91/119, 76.4%) had no significant difference in overall EIMs resolved at Week 52 compared to placebo (72/90, 80.0%; p = 0.542). Although many EIMs demonstrated reduction in prevalence compared to baseline at initiation of UST, only erythema nodosum was more likely to improve at Week 52 on treatment versus placebo.ConclusionOverall, UST did not lead to significant resolution of EIMs for CD compared to placebo at weeks 6 and 52.

Granulomatous vulvitis and Gullain-Barre syndrome in pediatric Crohn’s disease: a case report

Granulomatous vulvitis/cheilitis may occur rarely as an extraintestinal manifestation of Crohn’s disease (CD) and may precede the development of gastrointestinal symptoms. Guillain-Barre syndrome (GBS) is associated with a wide variety of illnesses including inflammatory bowel disease. Though the immunologic abnormalities in inflammatory bowel disease may encompass both granulomatous inflammation as well as autoimmune components, the combination of CD, GBS and granulomatous vulvitis/cheilitis in the same patient has not been described in literature. We hereby reported a 14 year old girl with granulomatous vulvitis/cheilitis for 4 years preceding the development of gastrointestinal manifestations of CD, who also had GBS during the course of hospitalization.

A case with Crohn's disease-associated spondyloarthritis exhibiting enhanced pro-inflammatory cytokine responses to Toll-like receptor ligands.

Despite the high incidence of spondyloarthritis (SpA) as an extra-intestinal manifestation of Crohn's disease (CD), the immunopathogenesis of CD-associated SpA remains largely unknown. We tried to explore molecular mechanisms accounting for the development of CD-associated SpA in a patient successfully treated with infliximab. Peripheral blood mononuclear cells (PBMCs) before infliximab treatment were stimulated with Toll-like receptor (TLR) ligands to measure pro-inflammatory cytokine responses. Endoscopic biopsy samples before and after infliximab treatment were subjected to quantitative polymerase chain reaction. PBMCs from this CD-associated SpA patient exhibited higher production of pro-inflammatory cytokines upon stimulation with TLR ligands than PBMCs from healthy controls. Induction of remission by infliximab was associated with the downregulation of pro-inflammatory cytokine responses in the small intestinal mucosa, which is continually exposed to TLR ligands. Excessive pro-inflammatory cytokine responses to TLR ligands might underlie the immunopathogenesis of CD-associated SpA.

S0702 Crohn's Disease Patients Treated With Anti-TNFs Have Lower Rates of Bronchiectasis

INTRODUCTION: Extraintestinal manifestations of Crohn's disease (CD) include pulmonary diseases. Bronchiectasis is the most commonly reported form of airway disease, but there are limited data on the effects of inflammatory bowel disease (IBD) treatment. Using a large database, we sought to describe the risk of bronchiectasis in CD patients and the effect of different IBD treatments. METHODS: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Crohn's disease” between 2016 and 2020 was identified. Subsequently, a cohort of patients of new diagnosis of “bronchiectasis” after 30 days of “Crohn's disease.” Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. RESULTS: Of the 39,328,760 individuals in the database, 181,670 had CD (0.46%). CD patients were 38.9% males, 80.4% Caucasian, and 71.1% in 18–65 years age group. The prevalence of patients with new diagnosis of bronchiectasis after at least 30 days of CD was 0.61% compared to 0.24% in the general population, P < 0.0001. Compared to the general population, patients with CD had higher association risk of bronchiectasis diagnosis [OR: 3.53; 95% CI: 3.36–3.82, P < 0.0001]. Among CD, predictors of having bronchiectasis included being elderly (>65 year old), female, Caucasian, and smokers [OR: 1.79; 95% CI: 1.61–2.01, P < 0.0001]. CD patients treated with anti-TNFs had lower rates of bronchiectasis [OR: 0.81; 95% CI: 0.70–0.93, P = 0.0027] whereas thiopurines had no significant effect [OR: 1.11; 95% CI: 0.97–1.28, P = 0.1347] and 5ASAs, methotrexate had higher rates compared to other treatments [OR: 1.18; 95% CI: 1.05–1.32, P = 0.0042] and [OR: 2.02; 95% CI: 1.69–2.42, P < 0.0001] respectively (Table 1). CONCLUSION: In this large database, we found a higher risk association between CD and bronchiectasis. CD patients who received anti-TNFs had lower rates of bronchiectasis. More data are needed, but it is possible that bronchiectasis is a TNF mediated extraintestinal manifestation and that anti-TNFs are protective.Table 1

Keep an Eye Out for Crohn's Disease: Orbital Myositis as the Initial Sign before Gastrointestinal Manifestations.

Extraintestinal manifestations of Crohn’s disease sometimes occur and can present prior to intestinal symptoms. Ocular manifestations of Crohn’s disease are considered rare, with orbital myositis an even rarer manifestation with only a handful of cases reported in the literature. We present the case of a young woman who was diagnosed with orbital myositis, which was initially attributed to pseudotumor cerebri after an extensive negative work-up. Months later, the patient presented with haematochezia, and was subsequently diagnosed with Crohn’s disease.LEARNING POINTSOrbital myositis is a rare manifestation of inflammatory bowel disease (IBD), and even more rarely is the initial presentation before the development of intestinal luminal disease.Orbital myositis is a rare extraintestinal manifestation of Crohn’s disease and mimics thyroid ophthalmopathy. When a thyroid function test is negative, it is important to keep IBD in mind.

Desquamative Inflammatory Vaginitis as an Extraintestinal Manifestation of Crohn’s Disease

To report the association between desquamative inflammatory vaginitis and Crohn’s disease in 4 women. Extraintestinal manifestations of inflammatory bowel disease (IBD) are a result of a complex interplay of multiple factors and these may or may not follow an independent course. Vulvar sequelae of Crohn’s disease have been described in the literature, but the impact of IBD on vaginal health is not well known. In all 4 patients, Crohn’s disease diagnosis was known to the patients, all of whom were managed by experienced gastroenterologists. However, the association of vaginal syndrome with IBD was not recognized by gynecologic or gastroenterology specialists. Successful management of DIV is unlikely until the bowel inflammatory process is adequately treated.

Extraintestinal manifestations of Crohn's disease: difficulties in diagnosis

Inflammatory bowel disease, a group of inflammatory conditions of the colon and small intestine, principally includes ulcerative colitis and Crohn's disease. Current attention to inflammatory bowel disease is promoted by worldwide increase in its incidence and morbidity as well as shortcomings of existing treatment. Extraintestinal (musculoskeletal, skin, renal, hepatic etc.) manifestations of inflammatory bowel disease significantly complicate the diagnosis and may predict the development of intestinal symptoms. In certain cases, the severity of extraskeletal manifestations may exceed that of the main diagnosis. Here we describe a clinical example of this scenario.

Evaluating inflammatory activity in Crohn's disease by cross-sectional imaging techniques.

The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease.

783 Nonalcoholic Fatty Liver Disease in a South Asian Crohn's Disease Population: External Validation of the St. Louis Steatosis Index

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease affecting one-quarter of the world population. NAFLD is also an extra-intestinal manifestation of Crohn's Disease (CD), where it is associated with higher morbidity and mortality. We aimed to (1) characterize risk factors for NAFLD in South Asian CD pts, and (2) externally validate a clinical prediction score for NAFLD in CD, the St. Louis Steatosis Index (SLSI). METHODS: We prospectively enrolled CD pts from 2/1/2019-5/31/2019 at the Asian Institute of Gastroenterology, a tertiary referral center for Inflammatory Bowel Disease (IBD) in India. Exclusion criteria included an alternative etiology of liver disease (e.g., chronic viral hepatitis). Controlled attenuation parameter (CAP) with transient elastography was measured using FibroScan® (Echosens, Waltham, MA) to quantitate hepatic steatosis and fibrosis. The outcome of NAFLD was defined as CAP ≥ 240 dB/m with the secondary outcome of hepatic fibrosis defined as ≥7 kPa. The SLSI operating characteristics were compared at re-calibrated low risk (&lt;10%) and high risk (&gt;40%) thresholds. The discrimination was compared to the Hepatic Steatosis Index (HSI) by both the C-statistic and net reclassification improvement (NRI) for the primary outcome and to both the HSI and the NAFLD fibrosis score (NFS) for the secondary outcome. RESULTS: 100 pts (63% male, median age 35 years) were enrolled with 42 (42%) demonstrating NAFLD and 6 (6%) demonstrating hepatic fibrosis. Univariate risk factors for NAFLD are shown (Table 1). Older age, male gender, elevated BMI, and presence of hypertension were significantly associated with a diagnosis of NAFLD. A low-risk SLSI was 71% sensitive and a high-risk SLSI was 93% specific for a diagnosis of NAFLD. SLSI showed fair discrimination for NAFLD but this was not different from the HSI (C statistic 0.747 vs 0.722; NRI +0.02). For the diagnosis of hepatic fibrosis, a low-risk SLSI was 83% sensitive and a high-risk score was 90% specific. The SLSI showed fair discrimination (0.767) that was superior to both the HSI (C statistic 0.587, NRI +0.47) and the NFS (C statistic 0.688, NR +0.23). CONCLUSION: NAFLD was common among this South Asian cohort with CD despite few traditional risk factors. The SLSI has fair discrimination for both NAFLD and the more clinically relevant subgroup with hepatic fibrosis. Further steps include exploring alternate mechanisms for this finding and devising more sensitive CD-specific screening tools for NAFLD.