Gorm Roager Madsen, Mohamed Attauabi, Johan F K F Ilvemark, Klaus Theede, Jacob Tveiten Bjerrum, Flemming Bendtsen, Jakob Benedict Seidelin, Rune Wilkens, Trine Boysen, Johan Burisch
{"title":"Intestinal Ultrasound Findings and Their Prognostic Value in Early Crohn's Disease - a Copenhagen IBD Cohort Study.","authors":"Gorm Roager Madsen, Mohamed Attauabi, Johan F K F Ilvemark, Klaus Theede, Jacob Tveiten Bjerrum, Flemming Bendtsen, Jakob Benedict Seidelin, Rune Wilkens, Trine Boysen, Johan Burisch","doi":"10.1016/j.cgh.2024.12.030","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>We characterize the sonographic features of Crohn's disease at diagnosis and evaluate the prognostic value of intestinal ultrasound during the early stage of disease.</p><p><strong>Methods: </strong>A prospective, population-based cohort of patients with newly diagnosed Crohn's disease were followed with intestinal ultrasound in conjunction with symptomatic, biochemical, and endoscopic evaluations.</p><p><strong>Results: </strong>Between May 2021 and April 2023, 201 patients with adult-onset Crohn's disease were recruited. No associations were found between sonographic inflammation at diagnosis and diagnostic delay. After three months, transmural remission was achieved in 38% of patients, with colonic disease patients achieving transmural remission more often. Transmural remission at three months was significantly associated with steroid-free clinical remission at three months and all subsequent follow-ups within the first year. Transmural remission was also associated with a lower risk of treatment escalation during follow-up until 12 months (26% vs. 53%, p=0.003). At 12 months, 41% had achieved transmural remission. Higher baseline body mass index negatively impacted the likelihood of 12-month transmural remission significantly (overweight: [OR 0.34 (0.12; 0.94)], obese: [OR 0.16 (0.04; 0.73)]). The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in the terminal ileum at diagnosis was the best predictor of ileocecal resection during the first year, with an optimal threshold of 63 (AUC 0.92, sensitivity 100%, specificity 73%).</p><p><strong>Conclusions: </strong>Transmural remission is an achievable outcome target for many newly diagnosed Crohn's disease patients and is associated with a favorable clinical outcome, including sustained steroid-free clinical remission. Further, intestinal ultrasound findings at diagnosis predict future ileocecal resection.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2024.12.030","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: We characterize the sonographic features of Crohn's disease at diagnosis and evaluate the prognostic value of intestinal ultrasound during the early stage of disease.
Methods: A prospective, population-based cohort of patients with newly diagnosed Crohn's disease were followed with intestinal ultrasound in conjunction with symptomatic, biochemical, and endoscopic evaluations.
Results: Between May 2021 and April 2023, 201 patients with adult-onset Crohn's disease were recruited. No associations were found between sonographic inflammation at diagnosis and diagnostic delay. After three months, transmural remission was achieved in 38% of patients, with colonic disease patients achieving transmural remission more often. Transmural remission at three months was significantly associated with steroid-free clinical remission at three months and all subsequent follow-ups within the first year. Transmural remission was also associated with a lower risk of treatment escalation during follow-up until 12 months (26% vs. 53%, p=0.003). At 12 months, 41% had achieved transmural remission. Higher baseline body mass index negatively impacted the likelihood of 12-month transmural remission significantly (overweight: [OR 0.34 (0.12; 0.94)], obese: [OR 0.16 (0.04; 0.73)]). The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in the terminal ileum at diagnosis was the best predictor of ileocecal resection during the first year, with an optimal threshold of 63 (AUC 0.92, sensitivity 100%, specificity 73%).
Conclusions: Transmural remission is an achievable outcome target for many newly diagnosed Crohn's disease patients and is associated with a favorable clinical outcome, including sustained steroid-free clinical remission. Further, intestinal ultrasound findings at diagnosis predict future ileocecal resection.
期刊介绍:
Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion.
As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.