P078. Splanchnic haemodynamics and intestinal vascularity in Crohn's disease. An in vivo evaluation using Doppler ultrasound, contrast-enhanced ultrasound and biochemical parameters
G. Maconi1, E. Bolzacchini1, S. Ardizzone2, F. Furfaro3, C. Bezzio1, J. Maier4, R. De Franchis1
1Gastrointestinal Unit L. Sacco university Hospital, Clinical Sciences, Milan, Italy; 2Ospedale L. Sacco, IBD Unit Gastroenterology-Oncology-Surgery, Como, Italy; 3Policlinico Universitario Messina, Gastroenterology, Messina, Italy; 4Patholohy Unit, Department of Clinical Ciences, Milan, Italy
Background: Crohn's disease (CD) is characterized by inflammation, angiogenesis and microvascular remodeling of affected bowel. These features have been associated with profound damage to mesenteric vascular blood supply and with impaired splanchnic haemodynamics (SH).
We evaluated in vivo the SH and intestinal microvascular changes in response to a standard meal in patients with ileal CD.
Methods: 16 consecutive patients with quiescent or active (2) ileal CD (8 male; mean age 39) in clinical observation and 10 healthy controls were included. Doppler ultrasound (US) of portal vein and superior mesenteric artery was used to assess conventional quantitative and semiquantitative indexes (flow volume, resistance and pulsatility indexes). The vascular perfusion of terminal ileum was assessed by color-Doppler US (resistance index of arteriolar bed of bowel wall) and real-time contrast-enhanced US (CEUS) with low-mechanical index, after the injection of 2.4 ml of sulfur hexafluoride-filled microbubbles (SonoVue, Bracco, Milan, Italy). The vascularity of the terminal ileum was quantified by a dedicated software (Q-ontrast, Bracco, Milan Italy) and different kinetic parameters of vascular perfusion calculated. Inflammation, angiogenesis and endothelial function were evaluated by measuring VEGF, TNF-alpha and NO. All measurements were performed before and 30 minutes after a standard caloric meal (Resource Energy Nestlè, 300 Kcal). Statistical analysis was performed using Wilcoxon and Spearman's rank correlation tests.
Results: Basal and postprandial SH and CEUS parameters did not significantly differ between CD patients and controls, whilst resistance index of arteriolar bed, detectable only in CD patients, showed a significant reduction after meal. NO and TNF-alpha significantly reduced after meal only in CD patients.
A significant correlation was found between CEUS parameters of vascular perfusion, and VEGF before the meal (r = 0.630.71; p < 0.05). Furthermore, we found a significant correlation between splanchnic blood flow and CEUS parameters of vascular perfusion during fasting (r = 0.660.79; p < 0.05), but not in the postprandial period.
Conclusions: In ileal CD patients, splanchnic blood flow is correlated with vascular perfusion of the intestinal wall, which is related to VEGF and likely with angiogenesis. This is evident only during fasting, but not in the post-prandial period, where other vasoactive factors are probably involved.