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P093. Impact of magnetic resonance enterography in the management of small bowel Crohn's disease

D.G. Cheriyan, E. Slattery, S. McDermott, C.D. Kingston, C. Donnelly, D. Keegan, H. Mulcahy, G.A. Doherty, D.E. Malone, S.J. Murphy

St. Vincent's University Hospital, Dublin, Ireland

Background: Crohn's disease (CD) is an autoimmune, chronic inflammatory condition of the gastrointestinal tract that typically affects young adults. The disease has a wide spectrum of clinical impact on patients, ranging from relatively asymptomatic disease to severe pathology requiring powerful immunomodulators and biological therapy. Radiological imaging is a useful means of assessing extent and severity of small bowel disease. With its lack of ionizing radiation and high tissue penetration, magnetic resonance imaging (MRI) has become a popular modality for assessing CD. Magnetic resonance enterography (MRE) is a relatively new imaging modality that involves small bowel distention with orally administered fluid.

Aims: To determine if MRE examination influences medical and surgical management of Crohn's disease.

Methods: From a prospectively maintained database of 2,655 IBD patients, we identified patients with histologically confirmed CD who underwent MRE between 2007 and 2010 in St. Vincent's University Hospital, Ireland. Demographic characteristics, disease activity indices (Harvey Bradshaw Index – HBI), C-reactive protein (CRP), smoking status, previous surgical history and prior medical therapy were analysed. The results of MRE and subsequent changes in patient management were evaluated.

Results: 31 females and 19 males with histologically confirmed CD were studied. The median age of the patients was 37 years (range 14–68), and median duration of disease before MRE was 10 years (range 1–35). 38 patients (76%) had ileo-colonic disease, and 12 patients (24%) had small bowel disease. 29 patients (58%) had previous resection for CD. 24% were smokers at the time of examination. The median HBI was 8 (range 2–10), and median CRP 6 (range 1–350). 70% of patients had a history of steroid use, 24% thiopurine use, and 12% had been on biological therapy. 13 patients (26%) had no active disease on MRE, 5 (10%) had fibrotic disease, 21 (42%) had active inflammatory disease, and 11 (22%) had both inflammatory and fibrotic disease. 34 out of 50 patients (68%) had a change in management as a direct result of the MRE. Of these 34 patients, 24 (71%) patients had changes in medical therapy, and 10 (29%) patients underwent surgery.

Conclusion: The majority of patients with small bowel CD who undergo MRE have a change in management as a result of the examination. MRE is a safe imaging modality, has a high clinical impact on patient management, and should therefore become the small bowel evaluation of choice in CD patients.