Andrea Magarotto

The role of ultrasound elasticity imaging in predicting ileal fibrosis in Crohn's disease patients

Backgound:Bowel wall fibrosis is associated with a complicated disease behavior in patients with Crohns disease (CD). The quantitative assessment of fibrosis severity in CD-affected bowel can help clinical decision making. Our aim was to evaluate the feasibility, reliability, and reproducibility of ultrasound elasticity imaging (UEI) toward the assessment of ileal fibrosis in CD patients. Methods:Twenty-three consecutive patients with ileal or ileocolonic CD, elected for surgical resection of the terminal ileum, underwent bowel ultrasound and UEI. Twenty inflammatory CD patients without complications were enrolled as controls. Bowel wall stiffness was evaluated with UEI by means of color scale and quantitative strain ratio measurement. The severity of bowel wall fibrosis and inflammation were evaluated on histological sections by semiquantitative and quantitative image analysis and used as a reference standard. Results:The UEI strain ratio measurement was significantly correlated with the severity of bowel fibrosis at both semiquantitative and quantitative histological image analysis: it was characterized by an excellent discriminatory ability for severe bowel fibrosis (area under the receiver operating characteristic curve: 0.917; 95% confidence interval, 0.788–1.000). UEI strain ratio measurements were characterized by an excellent interrater agreement. At multivariate analysis, bowel wall fibrosis proved the only independent determinant of the strain ratio. The ileal strain ratio of inflammatory CD patients was significantly lower than in operated CD patients with severe fibrosis. Conclusions:UEI can be used to assess ileal fibrosis in CD patients.

Ultrasound Elasticity Imaging Predicts Therapeutic Outcomes of Patients With Crohn’s Disease Treated With Anti-Tumour Necrosis Factor Antibodies

Background and Aims Ultrasound elasticity imaging is a non-invasive technique developed to evaluate fibrosis. Measuring tissue strain by ultrasound elasticity imaging can reliably detect severe ileal fibrosis in patients with Crohns disease [CD]. We have hypothesised that a more severe range of fibrosis might influence the therapeutic response to anti-tumour necrosis factor [TNF] treatment. The aim of this study was to assess the ability of ultrasound elasticity imaging to predict the therapeutic outcome for CD patients. Methods Consecutive patients with ileal/ileocolonic CD, starting anti-TNF treatment, were enrolled for the study. These patients underwent bowel ultrasound and ultrasound elasticity imaging at baseline and at 14 and 52 weeks after anti-TNF treatment. Bowel wall stiffness was quantified by calculating the strain ratio between the mesenteric tissue and the bowel wall. Strain ratio ≥ 2 was used to identify severe ileal fibrosis. Transmural healing at 14 and 52 weeks was defined as bowel wall thickness ≤ 3 mm. Results Thirty patients with CD were enrolled. Five patients underwent surgery for bowel obstruction. The frequency of surgeries was significantly greater in patients with a strain ratio ≥ 2 at baseline [p = 0.003]. A significant reduction of the bowel thickness was observed after 14 and 52 weeks of anti-TNF treatment [p < 0.005]. A significant inverse correlation was observed between the strain ratio values at baseline and the thickness variations following anti-TNF therapy [p = 0.007]; 27% of patients achieved transmural healing at 14 weeks. The baseline strain ratio was significantly lower in patients with transmural healing [p < 0.05]. Conclusions This study shows that ultrasound elasticity imaging predicts therapeutic outcomes for CD patients treated with anti-TNF.

P303 Ulcerative colitis (UC) in the elderly – Moderate at onset but then a milder course? An IG-IBD study

P302 Utility of “trough levels” determination and anti-infliximab antibodies in patients with inflammatory bowel disease. Estimation of individual pharmacokinetic parameters (PK) through population pharmacokinetic model G. Juan1,2 *, A. Alvarino3,4, L. Oltra4, N. Maroto4, N. Cano2, I. Ferrer2, J. Hinojosa2,4. 1Hospital de Manises, Farmacia Hospitalaria, Valencia, Spain, 2Hospital de Manises, Digestivo, Manises, Spain, 3Hospital de Manises, LABCO, Valencia, Spain, 4Hospital de Manises, Gastroenterology, Valencia, Spain

Evolving roles of cross-sectional imaging in Crohn's disease

The implementation of cross-sectional imaging techniques for the clinical management of Crohns disease patients has steadily grown over the recent years, thanks to a series of technological advances, including the evolution of contrast media for magnetic resonance, computed tomography and bowel ultrasound. This has resulted in a continuous improvement of diagnostic accuracy and capability to detect Crohns disease-related complications. Additionally, a progressive widening of indications for cross-sectional imaging in Crohns disease has been put forward, thus leading to hypothesize that in the near future imaging techniques can increasingly complement endoscopy in most clinical settings, including the grading of disease activity and the assessment of mucosal healing or Crohns disease post-surgical recurrence.

Surgery and diagnostic imaging in abdominal Crohn’s disease

Surgery is well-established option for the treatment of Crohn’s disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn’s disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors’ opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn’s disease and the roles played in these cases by diagnostic imaging modalities.RiassuntoLa chirurgia è un’opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell’anastomosi. Secondo l’opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.