P227. Impact of small intestine contrast ultrasonography in the management of Crohn's disease patients
E. Calabrese1, F. Zorzi1, E. Stasi1, E. Lolli1, G. Condino1, C. Petruzziello1, L. Biancone1, F. Pallone1, 1University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy
While there is sufficient data to support the use of small intestine contrast ultrasonography (SICUS) as a valuable and radiation-free tool in the detection of intestinal damage of small bowel Crohn's disease (CD), there is limited data showing its impact on patient management. Our aim was to evaluate whether SICUS has an impact in the clinical management of CD.
In our IBD database we identified patients with CD who underwent SICUS through one year (2011) and were followed up for at least one year. A total of 216 CD pts (121 M; median age 44 yrs; disease duration: median 139 mos; CD site: ileal in 171 pts, ileo-colonic in 45 pts; CD behavior: non-stricturing non-penetrating in 77 pts, penetrating in 44 pts, stricturing in 95 pts; previous ileocolonic resection in 113 pts) were included. CD therapy at the time of the examination included: 49% on 5-ASA, 26% on steroids, 1% on antibiotics, 8% on thiopurines, 13% on biological drugs, 2% on SMAD7 antisense oligonucleotide (GED0301), and 1% no therapy. Indications of patient evaluations were assessment of disease activity, obstructive symptoms, pre-surgical evaluation, and control after therapy.
After evaluation with SICUS a change in clinical management was made in 109/216 pts (50.5%). Eighteen pts underwent surgery and 91 pts experienced changes in medical therapy. Twenty-seven out of 91 pts started a steroid course; 14 pts started an antibiotic course; 20 pts were treated with immunosuppressives. Twelve pts started biological treatment. Six pts increased anti-TNFs maintenance dose. Three pts stopped biological therapy and one pt switched from Adalimumab to Infliximab. Eight pts were enrolled in the clinical trial GED0301. After SICUS median time of follow-up of pts who underwent a change in clinical management was 15.9 mos. One hundred and seven pts continued their treatment with a median time of follow up of 16.4 mos. Abnormal sonographic findings (bowel wall thickness, lesion extent, stenosis with or without dilation, fistula, and abscess) yielded significantly more in the group who experienced a change in clinical management compared with pts who continued previous treatment (p = 0.001).
More than half CD pts had a change in clinical management on the basis of SICUS. SICUS is a non-invasive, radiation-free and easily available imaging modality therefore its use should be implemented as part of a focused diagnostic examination in CD.