P431 Transabdominal ultrasonography to assess intestinal wall thickness and vascularity appears to predict therapeutic effects of steroid treatment in moderate-to-severe ulcerative colitis patients
T. Ogashiwa*1, M. Murakami1, S. Tsuda1, M. Nishio1, Y. Kogure1, K. Kasahara1, K. Hirai2, Y. Fukuno2, M. Jin2, A. Hanzawa2, H. Yonezawa2, K. Numata3, H. Kimura1, R. Kunisaki1
1Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan, 2Yokohama City University Medical Centre, Department of Laboratory Medicine and Clinical Investigation, Yokohama, Japan, 3Yokohama City University Medical Centre, Gastroenterology Centre, Yokohama, Japan
New, strong immunosuppressant therapies have been proven effective and are thus an alternative to colectomy in steroid-refractory ulcerative colitis (UC). However, implementing these immunosuppressant therapies may be difficult at general hospitals. Therefore, it is favourable to be able to anticipate steroid-refractory patients who need immunosuppressant therapies and/or colectomy before steroid treatment. This study aimed to investigate whether transabdominal ultrasonography (TAUS) can help to predict patients who may show steroid resistance and require switching to second-line therapy and/or colectomy.
In total, 100 moderate-to-severe UC patients who received steroid treatment and underwent TAUS before steroid treatment were included in the study. Calcineurin inhibitors and anti-tumour necrosis factor (TNF) therapy were defined as second-line therapies. Using TAUS, the main lesion in each patient was evaluated for bowel wall thickness (BWT) and blood flow. Blood flow was evaluated by colour Doppler ultrasound imaging using the semi-quantitative method (score 0–3). We analysed the correlations between BWT and blood flow score assessed by TAUS, and the probability of switching to second-line therapy and/or colectomy within 60 days.
Overall, 61 patients (61%) were steroid-responsive; 39 (39%) were steroid-refractory; 23 (23%) underwent second-line therapy alone; and 16 (16%) underwent colectomy within 60 days of steroid treatment. The mean BWT before steroid treatment was 6.7 ± 2.3 mm in the steroid-responsive group, and 8.0 ± 2.2 mm in the steroid-nonresponsive group. The mean blood flow score was 1.6 ± 1.1 in the steroid-responsive group, and 2.2 ± 0.9 in the steroid-nonresponsive group. The BWT and blood flow score were significantly higher in the steroid-nonresponsive group than in the steroid-responsive group (p = 0.005 and p = 0.016, respectively). Hence, the blood flow score was significantly higher in the colectomy group than in patients who did not require colectomy (p = 0.03). From a receiver-operating characteristic curve, the area over BWT > 7.0 mm was appropriate to predict second-line therapy (sensitivity 74.4%; specificity 53.1%) and colectomy (sensitivity 68.0%; specificity 45.2%). If the BWT was ≥ 7 mm, patients were switched to second-line therapy and colectomy with high probability (log-rank test p = 0.021 and p = 0.075, respectively).
The BWT and vascularity of intestinal lesions in moderate-to-severe UC patients evaluated by TAUS are well correlated with steroid resistance and the possibility of switching to second-line therapy alone or colectomy within 60 days.