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P579. Bowel damage after biological therapy assessed by Sonographic Lesion Index for Crohn's disease

F. Zorzi1, S. Zuzzi2, E. Stasi1, G. Bevivino1, C. Petruzziello1, L. Biancone1, C. Rossi2, F. Pallone1, E. Calabrese1, 1University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy, 2University of Rome Tor Vergata, Centro Interdipartimentale di Biostatistica e Bioinformatica, Rome, Italy

Background

Anti-TNFs have shown efficacy in Crohn's disease (CD). Mucosal healing represents a surrogate marker for this efficacy but the effects on structural damage are still poorly known. Small intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (SLIC: Sonographic Lesion Index for CD) was developed by using SICUS to assess CD lesions. SLIC derived from standardized variations of continuous (bowel wall thickness, lumen diameter and lesion length), discrete (number of lesions) and dichotomous variables (fistula, mesenteric adipose tissue alteration, abscess, lymphnodes). These variables were combined into a model to create an index value from 0 to 200. Index was subdivided into a severity scale of 5 classes from the lower (A) to the higher (E). Aim of the study was to evaluate intestinal damage variations after anti-TNFs using SLIC.

Methods

Twenty-six pts (16 M; mean age 36±12 yrs; disease duration 74±79 mos; disease behaviour: 4 pts penetrating, 12 pts stricturing, 10 pts non penetrating non stricturing) with established ileal or ileocolonic CD were enrolled. All pts received anti-TNFs for active luminal CD; 16 pts received adalimumab and 10 pts infliximab. Seven CD pts treated with mesalamine were enrolled as control group. Sonographic assessment was obtained before and after scheduled induction treatment. Disease activity was assessed by the CDAI.

Results

After treatment 19 pts experienced clinical remission, 5 pts had a clinical response and 2 pts were no responders. After treatment the CDAI were significant improved as compared to baseline (p < 0.0001). A significant improvement of SLIC after anti-TNFs was observed (p = 0.005). The wall thickness and the lumen narrowing subscores of SLIC showed a significant improvement (p = 0.004 and p = 0.007 respectively). In the control group with mesalamine no differences of CDAI, SLIC and index classes were observed. Before treatment 4 pts were included in class E, 5 pts in class D, 10 pts in class C, 5 pts in class B and 2 pts in class A; after treatment 14 out of 26 pts improved at least by one index class, 11 pts did not change class and 1 pt worsened class.

Conclusion

Our results suggest that anti-TNFs significantly improve bowel damage detected by SLIC and index classes. These new tools may be used to evaluate anti-TNFs treatment effects on bowel damage progression over time.