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Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohn's Disease
Alex Menys1, Jesica Makanyanga, Andrew Plumb
1*Centre for Medical Imaging, London, United Kingdom; and †Gastrointestinal Physiology Unit, University College London Hospital, London, United Kingdom.
Insights
Reduced small bowel motility variance in Crohn's disease (CD) is linked to increased inflammation and patient symptoms. This finding supports the idea that motility issues contribute to abdominal discomfort in CD patients.
Area of Science:
- Gastroenterology
- Medical Imaging
- Inflammatory Bowel Disease Research
Background:
- Enteric dysmotility is a suspected cause of abdominal symptoms in Crohn's disease (CD).
- Investigating the link between small bowel (SB) motility, inflammation, and symptom burden in CD is crucial.
Purpose of the Study:
- To explore the relationship between MRI-quantified SB motility, inflammatory markers, and symptom severity in CD patients.
- To determine if reduced SB motility in morphologically normal bowel correlates with disease activity and patient-reported outcomes.
Main Methods:
- Prospective study of 53 CD patients measuring Harvey-Bradshaw Index (HBI) and fecal calprotectin.
- Dynamic MRI enterography with a validated registration-based motility quantitation technique to assess SB motility.
- Correlation analysis between SB motility (mean and variance) and clinical/biochemical markers, adjusted for covariates.
Main Results:
- Motility variance, but not mean motility, was significantly negatively correlated with fecal calprotectin and HBI.
- Reduced motility variance was also associated with lower well-being, increased pain, and more diarrhea.
- These associations remained significant after adjusting for age, sex, smoking, and surgical history.
Conclusions:
- Decreased motility variance in morphologically normal SB is associated with higher inflammation and symptom burden in CD.
- This supports the hypothesis that inflammation-related enteric dysmotility contributes to refractory abdominal symptoms in Crohn's disease.
Background:
Inflammation-related enteric dysmotility has been postulated as a cause for abdominal symptoms in Crohn's disease (CD). We investigated the relationship between magnetic resonance imaging-quantified small bowel (SB) motility, inflammatory activity, and patient symptom burden.
Methods:
The Harvey-Bradshaw index (HBI) and fecal calprotectin were prospectively measured in 53 patients with CD (median age, 35; range, 18-78 years) the day before magnetic resonance enterography, which included a dynamic (cine), breath-hold motility sequence, repeated to encompass the whole SB volume. A validated registration-based motility quantitation technique produced motility maps, and regions of interest were drawn to include all morphologically normal SB (i.e., excluding diseased bowel). Global SB motility was correlated with calprotectin, HBI, and symptom components (well-being, pain, and diarrhea). Adjustment for age, sex, smoking, and surgical history was made using multivariate linear regression.
Results:
Median calprotectin was 336 (range, 0-1280). Median HBI, motility mean, and motility variance were 3 (range, 0-16), 0.33 (0.18-0.51), and 0.01 (0.0014-0.034), respectively. Motility variance was significantly negatively correlated with calprotectin (rho = -0.33, P = 0.015), total HBI (rho = -0.45, P < 0.001), well-being (rho = -0.4, P = 0.003), pain (rho = -0.27, P = 0.05), and diarrhea (rho = -0.4, P = 0.0025). The associations remained highly significant after adjusting for covariates. There was no association between mean motility and calprotectin or HBI (P > 0.05).
Conclusions:
Reduced motility variance in morphologically normal SB is associated with patient symptoms and fecal calprotectin levels, supporting the hypothesis that inflammation-related enteric dysmotility may explain refractory abdominal symptoms in CD.
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