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P227. Evaluation of safety and effectiveness of adalimumab therapy in symptomatic ileal Crohn's disease strictures

A. Echarri1, J. Gallego2, V. Ollero1, A. Porta2, J. Castro1

1Gastroenterology, Hospital A. Marcide, Ferrol, Spain; 2Radiology, Hospital A. Marcide, Ferrol, Spain

Introduction: Ileal Crohn's disease (CD) is characterized by a transmural inflammatory process usually leading to symptomatic stenosis. The difficulty remains in making a clinical determination of which strictures have an inflammatory or a fibrotic component due to different therapeutic approach.

Aims and Methods: We performed a prospective analysis of inflammatory strictures in ileal CD. Patients were treated with adalimumab (ADA) and followed up on over a period of one year. All patients received 160/80 mg as induction dose, followed by 40 mg eow for responders. Clinical response was assessed by the Harvey Bradshaw index (HBI). Before, at 6th month and one year after the beginning of ADA treatment, patients underwent ileoscopy and magnetic resonance enterography (MRE). Endoscopic activity was scored with the Simple Endoscopic Score (SES-CD), with values between 0 and 12. MRE was performed using a 1.0 T-MR system with gradient amplitude 15 mT/m (Intera, Philips, Best, The Netherlands). Patients were invited to drink 1.5 L of hyperosmolar water solution. MRE was evaluated in order to calculate an MR-activity index, taking into account both quantitative measurements (bowel wall thickness, degree of luminal stenosis and contrast enhancement) and qualitative evaluations (mucosal abnormalities, enlarged lymph nodes, fistulae and inflammatory masses). Possible MR-activity index scores ranged from 0 to 12. Differences between calculated means were compared using the Wilcoxon rank-sum test to compare nonparametric data.

Results: Eighteen patients with stricturing ileal CD and moderate-severe inflammatory stenosis (MRE index and SES-CD score >6), were included for adalimumab treatment (12 males, average age 34.6±9.8 years, 33% smokers). The Harvey Bradshaw index, ileal SES-CD score and MRE activity index were calculated before, at 6th month and one year after treatment. A reduction in the Harvey-Bradshaw index occurred after ADA treatment (p < 0.0000, paired Wilcoxon test). Improvement in inflammatory parameters was observed both in relation to the MRE activity index (p 0.003; p < 0.001) and the SES-CD score (p < 0.001), compared with 6 months and one year before. Only two patients (11%) stopped ADA treatment due to non-response and required surgery.

Conclusions: Differentiation between inflammatory and fibromatous strictures is particularly difficult yet crucial for therapeutic decisions. Patients with inflammatory Crohn's disease strictures may benefit from adalimumab treatment.