P195 MRI is predictive of, and anti-TNF treatment changes, the clinical course of Crohn's disease strictures
J. D. Schulberg*1,2, E. K. Wright1, B. A. Holt1,2, T. R. Sutherland2,3, S. J. Hume1, A. L. Ross1, A. L. Hamilton1,2, M. A. Kamm1,2
1Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia, 2Department of Medicine, The University of Melbourne, Melbourne, Australia, 3 Department of Radiology, St. Vincent's Hospital, Melbourne, Australia
Strictures are the most common Crohn’s disease (CD) complication but their natural history is unknown. There is a need to characterise inflammation and fibrosis, predict prognosis, and understand the impact of drug therapy.
Patients with a CD stricture diagnosed over a 5-year period with ≥12-month follow-up were reviewed for their clinical course, response to drug therapy, CRP, need for endoscopic dilatation, hospitalisation and surgery. Magnetic resonance enterography (MRE) scans at time of stricture diagnosis were reviewed blindly for disease extent and inflammation. Magnetic Resonance Index of Activity (MaRIA) score was calculated.
Characteristics of stricture patients: 136 patients: 77 had 1 and 59 had ≥2 strictures. Median age at stricture diagnosis was 40. Thirty-four per cent had previous CD surgery. Fifty-seven per cent were
MRE findings are highly predictive of future surgery. Three simple findings (pre-stricture dilatation, bowel wall thickness, stricture length) are strongly predictive of subsequent surgery. These MRI findings predict future disease course and can identify patients who may benefit from treatment intensification. Anti-TNF therapy is associated with a reduced risk of surgery if commenced at stricture diagnosis, and appears to alter the natural history of this complication.