P190 Computed tomography enterography and biomarkers in detecting active and complicated small bowel Crohn's Disease
A. Brincat*1, K. Micallef2, N. Azzopardi1, P. Ellul1
1Mater Dei Hospital, Department of Gastroenterology, Tal Qroqq, Malta, 2Mater Dei Hospital, Department of Radiology, Tal Qroqq, Malta
Computed tomography enterography (CTE) is one of the modalities in the evaluation of small bowel (SB) Crohn`s disease (CD). It can provide assessment of disease activity, extramural abnormalities and SB complications in patients with CD. This procedure is however associated with radiation exposure. In this group of patients SB investigation by capsule endoscopy may be complicated by capsule retention. Magnetic resonance enterography (MRE) is another alternative. However, it is far from perfect due to patient claustrophobia, long scanning times and movement artifacts. The aim of this retrospective study was to determine the clinical indications and findings on CTE as well as to determine if any biochemical biomarkers (CRP, ESR, platelets, haemoglobin and Red cell distribution width) can predict significant pathologies.
This was a retrospective analysis on all CTE performed on CD patients in our centre over a 1 year period (October 2013 to September 2014). The clinical indications, biochemical markers and CTE findings in these patients were analysed.
40 CD patients (26 females, mean age: 30.8 years, range: 18-75) underwent CTE. The main indications for CTE were abdominal pain/discomfort and/or symptoms suggestive of SB obstruction.
25% of CD patients had active inflammation and SB stricture and 2.5% had active inflammation, SB stricturing and fistulating disease. All of these patients had 1 or more raised inflammatory biomarkers. 30% of patients with active SB inflammation on CTE had a rise in 1 or more of the inflammatory biomarkers. Two patients with SB inflammation (5%) had normal biomarkers. The latter were also raised in those patients with normal SB but other intra-abdominal pathology. These patients had active colitis (5%), aortitis (2.5%), colonic fistulating disease (2.5%) and splenomegaly (2.5%). All patients with normal SB (25%) on CTE had normal inflammatory markers
CTE is useful in detecting active and complicated SB disease. It is less useful with quiescent disease. In CD patients, due to their young age and risk of radiation exposure, the presence of normal biomarkers should alert the clinician to question the real need for CTE. CE with patency capsule and/or MRE should be considered as alternatives.