Year 2021 / Volume 113 / Number 7
Original
Prognostic value of ultrasound activity and parietal healing in patients with Crohn’s disease

494-499

DOI: 10.17235/reed.2020.7347/2020

Cristina Suárez Ferrer, Joaquín Poza Cordón, Olivia Crivillén Anguita, Patricia Mayor Delgado, José Luis Rueda García, Eduardo Martín Arranz, María Sánchez Azofra, Jesús Noci Belda, Laura García Ramírez, María Dolores Martín Arranz,

Abstract
Introduction: the “treat to target” strategy for the management of patients with Crohn’s disease (CD) requires simple, reliable and non-invasive tools for continuous monitoring of the disease. Intestinal ultrasound has been proposed as an emerging technique that could be very useful in this field. Material and methods: patients who had undergone an intestinal ultrasound in the clinical practice between February 2013 and October 2018 at our hospital were retrospectively included. The evolution of the patients during follow-up was assessed based on the presence of ultrasound activity and the therapeutic changes based on the results. Results: two hundred and seventy-seven CD patients were included and the median follow-up time was 24 months (range 5-73 months). Signs of ultrasound inflammatory activity were identified in 166 patients (60 %), and of them, treatment was escalated in 116 patients (70 %) based on the results of the ultrasound. Among patients with identified ultrasound activity, in 166 patients (60 %) the evolution was less favorable than in those without activity, with a shorter time until the next outbreak. Thus, the median disease-free survival (without outbreaks) after performing the ultrasound was 18 months when ultrasound activity was identified (although in most of the patients [70 %] the treatment had been escalated) vs 47 months in patients without ultrasound activity. However, these differences were not statistically significant (p < 0.0001). Among the 111 patients without ultrasound activity, those who achieved “parietal healing” (74 patients) had a better evolution with a 12 % subsequent outbreak vs 27 % during follow-up (p = 0.05). Thus, 15 % of patients with parietal healing had an outbreak vs 34 % of those who had not normalized the ultrasound findings after three years of follow-up. Conclusion: intestinal ultrasound is a technique capable of detecting inflammatory activity in patients with Crohn’s disease and the presence of ultrasound activity is a risk factor for a new outbreak of activity and/or clinical relapse. Likewise, the presence of “parietal or transmural healing” (PH) is associated with a better evolution of patients during follow-up. Thus, it could be a more precise objective to consider deep remission in CD, with intestinal ultrasound being a useful technique for this purpose.
Share Button
New comment
Comments
No comments for this article
References
1.- .- Bouguen G, Levesque BG, Feagan BG, Kavanaugh A, Peyrin-Biroulet L, Colombel JF, Hanauer SB, Sandborn WJ. Treat to target: a proposed new paradigm for the management of Crohn's disease.Clin Gastroenterol Hepatol. 2015 Jun; 13(6):1042-50.e2. doi: 10.1016/j.cgh.2013.09.006. Epub 2013 Sep 10.
2.- Agrawal M, Colombel JF. Treat-to-Target in Inflammatory Bowel Diseases, What Is the Target and How Do We Treat?Gastrointest Endosc Clin N Am. 2019 Jul; 29(3):421-436. doi: 10.1016/j.giec.2019.02.004. Epub 2019 Apr 6.
3.- Gonzalez-Lama Y, Suarez C, Gonzalez-Partida I, et al. Timing of thiopurine or anti-TNF initiation is associated with the risk of major abdominal surgery in Crohn’s disease: a retrospective cohort study. Journal of Crohn’s & Colitis. 2016;10(1):55–60.
4. - Laboratory markers in IBD: useful, magic, or unnecessary toys? Vermeire S, Van Assche G, Rutgeerts P. Gut. 2006 Mar; 55(3):426-31
5.- Schoepfer AM, Beglinger C, Straumann A et al. Fecal calprotectin more accuerately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, C-reactive protein, platelets , hemoglobin and blood leukocytes. Inflamm Bowel Dis. 2013 Feb; 19(2):332-41.
6. - D´Haens G, Ferante M, Vermeire S. Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflammat Bowel Dis. 2012 Dec; 18(2):2218-24.
7. - Burri E, Bglinger C. Faecal calprotectin- a useful tool in the management of inflammatory bowel disease. Swiss Med Wkly. 2012; 142:w13557
8. - Rodriguez-Moranta F, Lobaton T, Rodriguez-Alonso L et al. Fecal calprotectin in the diagnosis of inflammatory bowel diseases. Gastroenterol Hepatol 2013 Jun-Jul; 36(6):400-6. doi: 10.1016/j.gastrohep.2012.10.008.
9. - Jonefjäll B, Strid H,Ohman L et al. Characterization of IBS-like symptoms in patients with ulcerative colitis in clinical remission. Neurogastroenterol Motill 2013. Jun. Epub ahead of print.
10. - Jelsness-Jorgensen LP, Bernklev T, Moum B. Calprotectin is a useful tool in distinguishing coexisting irritable bowel disease-like symptoms from that of occult inflammation among inflammatory bowel disease patients in remission. Gastroenterol Res Pract 2013; 2013:620707.
11.-Bouguen G., Levesque BG., Pola S., Evans E., Sandborn WJ. Endoscopic Assessment and Treating to Target Increase the Likelihood of Mucosal Healing in Patients With Crohn’s Disease. Clin Gastroenterol Hepatol 2014;12(6):978–85. Doi: 10.1016/j.cgh.2013.11.005.
12.- Al-Bawardy B, Hansel SL, Fidler JL, Barlow JM, Bruining DH. Endoscopic and Radiographic Assessment of Crohn's Disease.Gastroenterol Clin North Am. 2017 Sep; 46(3):493-513. doi: 10.1016/j.gtc.2017.05.005.
13.- Kopylov U, Koulaouzidis A, Klang E, Carter D, Ben-Horin S, Eliakim R. Monitoring of small bowel Crohn's disease. Expert Rev Gastroenterol Hepatol. 2017 Nov; 11(11):1047-1058. doi: 10.1080/17474124.2017.1359541. Epub 2017 Jul 30.
14.- Horsthuis K, Bipat S, Bennink RJ, et al. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008; 247(1):64–79.
15.- Fraquelli M, Colli A, Casazza G, et al. Role of US in detection of Crohn disease: meta-analysis. Radiology. 2005; 236(1):95–101
16.- Fraquelli M, Sarno A, Girelli C, et al. Reproducibility of bowel ultrasonography in the evaluation of Crohn’s disease. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2008; 40(11):860–866.
17.- Calabrese E, Maaser C, Zorzi F, et al. Bowel ultrasonography in the management of Crohn’s Disease. a review with recommendations of an international panel of experts. Inflamm Bowel Dis. 2016; 22 (5):1168–1183.
18.- Calabrese E, Zorzi F, Zuzzi S, et al. Development of a numerical index quantitating small bowel damage as detected by ultrasonography in Crohn’s disease. Journal of Crohn’s & Colitis. 2012; 6 (8):852–860.
19.- Paredes JM, Moreno N, Latorre P, Ripollés T, Martinez MJ, Vizuete J, Moreno-Osset E. Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn's Disease. Dig Dis Sci. 2019 Mar 14. doi: 10.1007/s10620-019-05567-w. [Epub ahead of print]
20.- Serban ED. Treat-to-target in Crohn's disease: Will transmural healing become a therapeutic endpoint? World J Clin Cases. 2018 Oct 26;6(12):501-513. doi: 10.12998/wjcc.v6.i12.501.
21.- Fernandes SR, Rodrigues RV, Bernardo S, Cortez-Pinto J, Rosa I, da Silva JP, Gonçalves AR, Valente A, Baldaia C, Santos PM, Correia L, Venâncio J, Campos P, Pereira AD, Velosa J.Transmural Healing Is Associated with Improved Long-term Outcomes of Patients with Crohn's Disease. Inflamm Bowel Dis. 2017 Aug;23(8):1403-1409. doi: 10.1097/MIB.0000000000001143.
22.- PanésJ, BouzasR, ChaparroM, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther2011; 34:125–45.
23.- Parente F, Greco S, Molteni M, et al. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy. Gut2004; 53:1652–7.
24.- Christian Maaser, Andreas Sturm, Stephan R Vavricka et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications, Journal of Crohn's and Colitis, Volume 13, Issue 2, February 2019, Pages 144–164K
25.- Kucharzik T, Wittig BM, Helwig U, et al. Use of Intestinal Ultrasound to Monitor Crohn's Disease Activity. Clin Gastroenterol Hepatol. 2017;15(4):535-542.e2. doi:10.1016/j.cgh.2016.10.040
26.- Zorzi F, Stasi E, Bevivino G, et al. A sonographic lesion index for Crohn’s disease helps monitor changes in transmural bowel damage during therapy. Clin Gastroenterol Hepatol 2014; 12:2071–7.
27.- Kucharzik T, Wittig BM, Helwig U, et al. Use of Intestinal Ultrasound to Monitor Crohn’s Disease Activity. Clin Gastroenterol Hepatol 2017; 15:535–42
28.- Juan L. Mendoza, Yago González-Lama, Carlos Taxonera et al. Using of magnetic resonance enterography in the management of Crohn’s disease of the small intestine: First year of experiencia. Rev Esp Enferm Dig. Vol. 104. N.° 11, pp. 578-583, 2012
29. - Moreno N, Ripollés T, Paredes JM, Ortiz I, Martínez MJ, López A, Delgado F, Moreno-Osset E . Usefulness of abdominal ultrasonography in the analysis of endoscopic activity in patients with Crohn's disease: changes following treatment with immunomodulators and/or anti-TNF antibodies. J Crohns Colitis. 2014 Sep;8(9):1079-87. doi: 10.1016/j.crohns.2014.02.008.
30.- Sauer CG, Middleton JP, McCracken C, Loewen J, Braithwaite K, Alazraki A, Martin DR, Kugathasan S. Magnetic resonance enterography healing and magnetic resonance enterography remission predicts improved outcome in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2016;62:378-383.
Related articles

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Digestive Diseases Image

Peristomal cutaneous Crohn's disease by contiguity

DOI: 10.17235/reed.2022.8909/2022

Letter

Anal neoplasia and perianal Crohn’s disease: myth or reality?

DOI: 10.17235/reed.2021.8317/2021

Letter

Crohn’s disease in patients treated with etanercept

DOI: 10.17235/reed.2019.6554/2019

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Letter to the Editor

Adnexal localization of Crohn’s disease and recurrent massive ovary cysts

DOI: 10.17235/reed.2016.4301/2016

Case Report

Metastatic Crohn’s disease in pediatrics

DOI: 10.17235/reed.2016.3948/2015

Letter to the Editor

Crohn’s disease and Sweet’s syndrome: A debut together

DOI: 10.17235/reed.2015.3842/2015

Case Report

Ovarian involvement in Crohn´s disease: A rare complication

DOI: 10.17235/reed.2015.3764/2015

Citation tools
Suárez Ferrer C, Poza Cordón J, Crivillén Anguita O, Mayor Delgado P, Rueda García J, Martín Arranz E, et all. Prognostic value of ultrasound activity and parietal healing in patients with Crohn’s disease. 7347/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 696 visits.
This article has been downloaded 204 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 16/06/2020

Accepted: 17/09/2020

Online First: 02/12/2020

Published: 07/07/2021

Article revision time: 90 days

Article Online First time: 169 days

Article editing time: 386 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology