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Ultrasound Is Valuable in Assessing Treatment Response, Guiding Treatment Strategy, and Predicting Outcomes in Small
Ze-Min Han1,2, Welera Haissou Elodie1, Wen-Juan Zhang1
1Institute of Gastroenterology of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Objectives:
The role of ultrasound in small bowel stricturing Crohn's disease (CD) is unclear. We aimed to investigate whether intestinal ultrasound can be used to monitor treatment response, guide treatment strategy, and predict outcomes in small bowel stricturing CD.
Methods:
We performed a multicenter retrospective study of 121 consecutive patients with small bowel stricturing CD who received biological therapy for at least 3 months. Two kinds of ultrasonographic response were evaluated: inflammation response (improvement in bowel wall thickness and vascular intensity) and stricture response (inflammation response with no luminal narrowing). Treatment was optimized when no inflammation response or loss of inflammation response was detected. Cox regression analysis was performed to investigate the predictors of CD-related hospitalization.
Results:
The rate of inflammation response increased from 57.0% at the end of induction therapy (date 1) to 67.8% 1 year later (date 2) (p = .031). No significant difference was observed for the rate of stricture response between date 1 and date 2 (28.1% versus 27.3%, p = 1.000). Ultrasound led to 91 treatment optimizations, after which 29 patients achieved inflammation response and 9 achieved stricture response. Multivariate analysis showed that stricture response at the end of induction therapy was independently associated with a decreased risk for CD-related hospitalization (hazard ratio 0.29, 95% CI 0.09-0.96; p = .043).
Conclusion:
Intestinal ultrasound can be used to monitor treatment response and guide treatment strategy in small bowel stricturing CD. Early stricture response on intestinal ultrasound is associated with improved outcomes.
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