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P308 Utility of bowel ultrasound in diagnosing disease activity in Crohn’s disease: Indian experience

P. Kakkadasam Ramaswamy*1, K. V. Nagarajan1, A. Yelsangikar1, A. Nagar1, N. Bhat1

1Aster CMI Hospital, Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Bangalore, India

Background

To assess the utility of bowel ultrasound (USG) in assessing Crohn’s disease activity in correlation with the simple-endoscopic score-CD (SES-CD) and Harvey–Bradshaw Index (HBI).

Methods

Patients with Crohn’s disease who underwent colonoscopy for assessment of disease activity also underwent a USG within a 2-week period without change in treatment. Colonoscopic disease activity was assessed by the SES-CD, SES-CD score of 3 and higher was defined as endoscopically active. Clinical disease activity was assessed by the HBI, and a HBI of 5 or more was defined as active disease. USG parameters assessed include bowel wall thickness (BWT), loss of bowel wall stratification (BWS), and Doppler activity. Doppler activity was evaluated semi-quantitatively by the Limberg score.

Results

Thirty-five patients were included in the study, 12 patients (34%) were in endoscopic remission, 7 patients (20%) had mild endoscopic activity, 6 patients (17%) had moderate endoscopic activity and 10 patients (29%) had severe endoscopic activity as per the SES-CD score. As per the HBI, 18 (51%) patients were in remission, 6 (17%) had mild, 8(23%) had moderate and 3 patients (9%) had severe disease. Sixteen (46%) patients had only small intestinal involvement, 13 (37%) ileocolonic and 6 (17%) colonic only. Median BWT was greater in patients with active disease when compared with those in endoscopic remission (6 mm vs. 2.45 mm, p < 0.01). BWT correlated with SES-CD (r = 0.455, p = 0.007) and HBI (r = 0.506, p = 0.002). BWS correlated with SES-CD (r = 0.432, p = 0.011) and HBI (r = 0.483, p = 0.003),Doppler correlated with SES-CD ( r = 0.494, p = 0.003) and HBI (r = 0.656, p = 0.001). Combining all 3 features (BWT, BWS, Doppler) correlated to SES-CD for active disease (r = 0.8, p = 0.009) and to HBI (r = 0.76, p = 0.04).

Conclusion

USG is a useful modality in assessing disease activity in Crohn’s disease. Bowel wall thickness, loss of stratification, and Doppler activity in the bowel wall correlate with endoscopic and clinical disease activity; and these features can be used in future studies assessing using USG to assess disease activity in Crohn's disease.