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P257 Prognostic value of bowel ultrasonography for the management of Crohn’s disease

C.J. Suarez Ferrer, J. Poza Cordon, O. Crivillen Anguita, E. Martin Arranz, J.L. Rueda Garcia, M. Sanchez Azofra, L. Garcia Ramirez, J. Noci Belda, M.D. Martin Arranz

Department of Gastroenterology, Hospital Universitario La Paz, Madrid, Spain

Background

The ‘treat to target’ strategy for managing patients with Crohn’s disease (CD) requires simple, reliable and non-invasive monitoring tools. Bowel ultrasound is an emerging technology that could be useful in this field. The aim of our study is to determine whether bowel ultrasound is a useful tool to assess activity in CD and if its results correlate with long-term evolution of the disease.

Methods

Patients who had a bowel ultrasound for clinical practice between February 2013 and October 2018 in our centre were retrospectively included. Evolution of patients was assessed at follow-up based on the presence of echographic signs of activity and therapeutic changes solely based on echographic features.

Results

277 CD patients were included, of which 51% (142 patients) are women with a mean age at diagnosis of CD 35.3 years old (18.7 SD). The median follow-up time was 24 months (range 5–73 months). Among patients included, echographic signs of inflammatory activity were identified in 166 patients (60%). Out of these, 116 patients (70%) received treatment step-up based on the results of ultrasound. It was observed that out of the 161 patients (58%) in which of the attending physician did not modify treatment after performing ultrasound, only 43 had activity on ultrasound (26.7%). Also among patients whose treatment was scaled, 100% had echographic activity. These differences reached statistical significance (p < 0.0001). Among patients with echographic activity, disease evolution was worse than in those without activity, presenting less time to the next disease flare. Thus median disease-free survival (without flares) after performing ultrasound was 18 months when ultrasonographic activity identified (although in most patients (70%) treatment was scaled) vs. 47 months in patients without ultrasound activity, with statistically significant differences (p < 0.0001).

Conclusion

Intestinal ultrasound is a technique capable of detecting inflammatory activity in patients with Crohn’s disease and the presence of ultrasound activity is a risk factor for a subsequent activity flare and/or clinical relapse.