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Background and Aims

Mucosal healing is associated with better outcomes in Crohn's disease (CD). Colonoscopy (CS) is invasive and poorly tolerated. Bowel ultrasound (US) is a non-invasive tool that is increasingly being used for CD assessment.

We assessed the predictive role of baseline bowel US findings on disease course in a large prospective cohort of CD patients for 12 months.

Methods

Ileo-colonic CD consecutive patients were followed for 12 months after performing bowel US. The negative course of CD, defined as the need for steroids and/or change of therapy and/or hospitalization and/or the need for surgery, was assessed. We evaluated this composite endpoint and subsequently considered each individual endpoint separately. Predictors of negative disease course were analyzed by logistic regression analysis.

Results

225 ileal and/or colonic CD consecutive patients were included in the study. We analyzed the association between baseline bowel US parameters and endoscopic activity (defined as a SES-CD >2) to set up a non-invasive quantitative ultrasound-based score (BUSS). The multivariable analysis identified as independent predictors of a worse outcome throughout the 12-month period as being: BUSS >3.52 (OR 6.97, 95% CI 2.87-16.93, P<0.001), presence of at least one disease complication (stricture, fistula, abscess) at baseline bowel US (OR 3.90, 95% CI 1.21-12.53, P=0.021), fecal calprotectin value ≥250 μg/g at baseline (OR 5.43, 95% CI 2.25-13.11, P<0.001), and male gender (OR 2.60, 95% CI 1.12-6.02, P=0.025).

Conclusion

Bowel US predicts the 12-month course in CD.

You can read an interview with the lead study author here, and about the clinical implications of the study here.