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P198. MRE and colonoscopy findings in early Crohn's disease predict the course of the disease: a prospective observational cohort study

G. Fiorino1, L. Peyrin-Biroulet2, C. Bonifacio3, P. Naccarato1, G. Lo Bue3, A. Malesci4, O. Sociale1, L. Balzarini3, S. Danese1, 1IRCSS Humanitas, IBD Center, Rozzano, Italy, 2Nancy University Hospital, Iinserm U954, Nancy, France, 3IRCCS Humanitas, Radiology, Rozzano, Italy, 4IRCCS Humanitas, Gastroenterology and Digestive Endoscopy, Rozzano, Italy

Background

Crohn's disease (CD) is a chronic progressive disease which can evolve in bowel damage (BD), and often leads to hospitalization and surgery due to complications. Diagnostic delay may reduce the chance to impact on the natural course of the disease. MRI is complementary to colonoscopy to assess intestinal and extravisceral complications since diagnosis. The value of MRI findings in early Crohn's disease to predict the course of Crohn's disease is unknown.

Methods

Thirty-four patients with newly-diagnosed CD underwent magnetic resonance enterography (MRE) and colonoscopy within 18 months since diagnosis (mean time 5.5 months, range 0–15.2). The primary objective was to assess the rate of BD at diagnosis. BD was defined as presence of complications (stricture, fistula, abscess). Secondary outcomes was to identify the prognostic role of MRE findings in terms of clinical relapse, surgery and hospitalization in the study population, comparing patients with BD at diagnosis and patients who had not. Statistical analysis was performed using χ2 test, survival analysis and logrank test. Differences were considered significant if p < 0.05.

Results

Subjects were prospectively evaluated by MRE and colonoscopy between 2007 and 2012. Twenty subjects (58.5%) had BD at diagnosis: 17 (50%) had radiological complications (stricture, fistula or abscess) and 15 (44.1%) at colonoscopy (stricture or fistula).

Sixteen patients (47.1%) had a clinical relapse during the follow-up period, 15 subjects (44.1%) needed hospitalization related to CD, and 10 (29.7%) required surgical intervention.

Comparing subjects with BD at diagnosis with controls, as assessed by MRE and colonoscopy, 10 patients with complications at diagnosis required surgery compared to none of patients with no complications (29.7% vs. 0%, p = 0.005), 13 had a clinical relapse compared to 3 (38.2% vs. 8.8%, p = 0.03), and 13 patients required hospitalization compared to 3 (38.2% vs. 5.9%, p = 0.009). Survival analysis and logrank test showed that patients with BD at diagnosis had higher risk to be hospitalized (HR 0.16, p = 0.005), to have a clinical relapse (HR 0.23, p = 0.01), or to undergo surgery (HR 0.0, p < 0.002). Thickening, edema, or contrast-enhancement at diagnosis did not have predictive role.

Conclusion

Bowel damage assessed by MRE and colonoscopy is present in 58.5% of patients with newly diagnosed CD. MRE plays a key role in identifying bowel damage at early stages. Presence of bowel damage in early CD is predictive of a worse outcome.