P706 Monitoring asymptomatic patients with Crohn's disease: the role of intestinal ultrasound
Dussias, N.(1)*;Melotti, L.(1);Mazzotta, E.(1);Decorato, A.(1);Vanigli, N.(1);Rizzello, F.(1);Gionchetti, P.(1);
(1)IRCCS Azienda Ospedaliero-Universitaria Policlinico S. Orsola - Malpighi, Department of Medical and Surgical Sciences, Bologna, Italy;
Background
Intestinal Ultrasound (IUS) is a non-invasive, widely available technique that can rapidly evaluate bowel wall thickness and provide direct visualization of bowel vascularisation and motility. Studies have shown high concordance between ultrasound and MR enterography and endoscopy for disease location and activity, and fewer technical difficulties associated with IUS. While more is known about the role of IUS in evaluating response to pharmacologic treatment in CD patients, data regarding the monitoring of asymptomatic patients are scarce. Our objective was to study the impact of IUS in the management of patients with CD in stable clinical remission in a real-world setting.
Methods
We conducted a retrospective, monocentric observational study in patients with CD in clinical remission (Harvey Bradshaw Index ≤ 4), not in treatment with immunomodulators/immunosuppressants, in whom annual monitoring via IUS was performed. Biochemical data including C-reactive protein (CRP) and relevant ultrasound parameters (bowel wall thickness, extension and vascularization via Limberg score) were recorded. Changes in treatment or the need for second-level diagnostic tests based on ultrasound findings were registered along with outcomes at 1 year follow-up.
Results
A total of 201 patients with CD underwent IUS at our center between March and May 2021. Of these, 86 were in clinical remission with mesalazine treatment/no treatment. In 49/86 (57%) of cases, significant ultrasound findings were reported. In 27/49 cases, ultrasound findings led to a treatment modification or a second-level diagnostic test. Specifically, 12 patients were started on a course of oral budesonide or metronidazole; of these, 6 were in remission at 1 year follow-up, 3 patients required surgery within 1 year, and 2 experienced a disease flare treated with a second course of budesonide. Of the 15 patients in which a second-level diagnostic test was performed, in 12 cases disease activity was confirmed: 6 were started on a course of budesonide or metronidazole with persistent clinical remission at 1 year, 2 were started on biologics, and 4 developed complications during the follow-up period and were referred for surgery. In the remaining 3 cases, the second level diagnostic test excluded active disease and the patients maintained clinical remission at 1 year follow-up.
Conclusion
The results of this study demonstrate how IUS can be a useful tool that can modify treatment strategies and stratify patients requiring more invasive second-level diagnostic exams, with the objective of reducing clinical relapses. Prospective, randomized studies with large cohorts are needed to confirm these findings.