P512 Bowel ultrasound is useful in Crohn's disease monitoring: Analysis from the TRUST study in Germany
T. Kucharzik*1, B.M. Wittig2, U. Helwig3, A. Roessler2, S. Rath2, C. Maaser1
1City Hospital Lueneburg, Clinic of Internal Medicine and Gastroenterology, Lueneburg, Germany, 2AbbVie Deutschland GmbH & Co. KG, Medical Department, Wiesbaden, Germany, 3Gastroenterology Practice, IPO, Oldenburg, Germany
Reliable tools for measuring parameters of disease activity in patients with Crohn's disease (CD) are desirable. The purpose of this study is to characterise ultrasound (US) parameters, which allow individual disease follow-up and thus help to monitor response to therapy. The hypothesis of the TRUST (TRansabdominal Ultrasonography of the bowel in Subjects with Crohn's disease To monitor disease activity) study is that transabdominal US is an easy to use, easily repeatable, and accurate diagnostic tool in the assessment of CD activity and in monitoring the course of the disease, and in the early detection of CD complications.
TRUST is an ongoing prospective, observational multicentre study in Germany (51 sites) in patients with active CD. The primary objective of this study is the prospective evaluation of bowel wall US in order to assess its value in monitoring CD patients in routine medical practice. Standard follow-up is clinical, using Harvey-Bradshaw Index (HBI).
For 100 of 232 patients with active CD enrolled in TRUST complete follow-up of 12 months was available. The patients' median age was 32 yrs, with a median disease duration of 3.8 yrs. All patients (63% female) displayed acute inflammatory symptoms at baseline, with at least moderate disease activity which required an initiation or escalation of treatment. At the baseline US examination, most patients showed bowel wall thickening (BWT) in the terminal ileum (70% of patients) and sigmoid colon (54%). BWT (measured in mm) decreased significantly at almost all colonic areas after 3 and at all after 12 months. Loss of bowel wall stratification, fibro-fatty proliferation and moderately or markedly increased signals in color Doppler US (Limberg scores of 3 or 4) was shown in approximately half of the patients at baseline. After 12 months, US examination showed significant improvements of the following parameters (p<0,001): BWT (e.g. terminal ileum 70% to 40%, sigmoid colon 54% to 24%), loss of bowel wall stratification (54% vs 24%), and fibro-fatty proliferation (47% vs 19%). Limberg scores also improved significantly (50% vs 12% with scores 3 or 4). Median HBI decreased from 10.5 at baseline to 1 at 12 months.
In this analysis, US examination was useful to monitor disease activity and response to therapy in CD patients. Almost all examined bowel US parameters improved significantly within 12 months from treatment intensification. Improvement of BWT, bowel wall stratification and mesenteric fibro-fatty proliferation might be useful in monitoring early and long term response to treatment. The US changes were accompanied by a significant decrease of clinical disease activity as measured by HBI.