Original article
Alimentary tract
Use of Intestinal Ultrasound to Monitor Crohn’s Disease Activity

https://doi.org/10.1016/j.cgh.2016.10.040Get rights and content

Background & Aims

We performed a multicenter study to determine whether transabdominal bowel wall ultrasonography, a noninvasive procedure that does not require radiation, can be used to monitor progression of Crohn’s disease (CD).

Methods

We performed a 12-month prospective, noninterventional study at 47 sites in Germany, from December 2010 through September 2014. Our study included 234 adult patients with CD who experienced a flare, defined as Harvey-Bradshaw index score of ≥7. All patients received treatment intensification, most with tumor necrosis factor antagonists. Ultrasound parameters and clinical data were assessed at baseline and then after 3, 6, and 12 months. The primary endpoint was the change in ultrasound parameters within 12 months of study enrollment.

Results

All patients included had bowel wall alterations either within the terminal ileum and/or segments of the colon. After 3 and 12 months, ultrasonographic examination showed significant improvements of nearly all ultrasound parameters, including reductions in bowel wall thickening or stratification, decreased fibrofatty proliferation, and increased signals in color Doppler ultrasound (P < .01 for all parameters at months 3 and 12). Median Harvey-Bradshaw index scores decreased from 10 at baseline to 2 after 12 months. Improvement in bowel wall thickness correlated with reduced levels of C-reactive protein after 3 months (P ≤ .001).

Conclusions

In a multicenter prospective study, we found that ultrasonographic examination can be used to monitor disease activity in patients with active CD. Bowel ultrasonography seems to be an ideal follow-up method to evaluate early transmural changes in disease activity, in response to medical treatment. German Clinical Trials Register: drks.de/DRKS00010805.

Section snippets

Patients

A total of 234 patients were enrolled at 47 study sites (general practices, 39.5%; general hospitals, 39.5%; university hospitals, 19.0%) in Germany between December 2010 and September 2014. Patients were eligible if they were 18 years or older with a proven diagnosis of ileocecal and/or colonic CD and with currently at least moderate disease activity measured by the Harvey-Bradshaw index (HBI score ≥7). The patients in this noninterventional, prospective, multicenter study received standard of

Patient Population

A total of 234 patients were eligible for this study; data from 134 patients with accurate time intervals between baseline and the final visit could be analyzed (analysis population [AP] 1). AP2 constitutes the second AP, and includes 182 patients with accurate time intervals between baseline and the first follow-up visit at 3 months (for the definition of accurate time intervals, see Figure 1). The baseline characteristics of the different populations are shown in Table 1 and did not reveal

Discussion

The TRUST study indicates that US can be used to effectively monitor treatment response in patients with active CD. Significant improvement in US pathology can be observed 3 months after treatment intensification. Forty-seven centers with inflammatory bowel disease specialists from different hospitals or outpatient clinics were involved in this trial. Comparable results between different gastroenterologists working at various level of medical care indicate that bowel US is a reliable tool to

Acknowledgments

The authors thank the patients for their support and their active participation in the research of IBD. They also thank all the members of the TRUST study group and their study nurses for the invaluable contributions to the success of this study. The members of the TRUST study group are listed in the Supplementary Materials. Finally, they thank Imma Fischer, Biostatistik Tübingen, for performing the statistical analyses.

References (23)

  • T. Ripollés et al.

    Crohn's disease and color Doppler sonography: response to treatment and its relationship with long-term prognosis

    J Clin Ultrasound

    (2008)
  • Cited by (162)

    • Crohn's disease

      2024, The Lancet
    View all citing articles on Scopus

    Conflicts of interest The authors disclose the following: Torsten Kucharzik has received lecture and consulting fees from AbbVie, MSD, Ferring, Falk Foundation, Takeda, UCB, Wolff Pharma, Biogen, Hospira, Mundipharma, and Janssen. Bianca M. Wittig is an employee of AbbVie, and owns AbbVie stock or options. Ulf Helwig has received lecture and consulting fees from AbbVie, MSD, Ferring, Falk Foundation, Takeda, Mundipharma, Hospira, Vifor Pharma, and Celltrion. Norbert Börner has received lecture and consulting fees from AbbVie, MSD, Ferring, Falk Foundation, and Takeda. Alexander Rössler is an employee of AbbVie, and may own AbbVie stock or options. Stefan Rath is an employee of AbbVie, and may own AbbVie stock or options. Christian Maaser has received lecture and consulting fees from AbbVie, MSD, Ferring, Falk Foundation, Takeda, and Wolff Pharma.

    Funding The design, study conduct, and funding for the study were supported by AbbVie Deutschland GmbH & Co KG. All authors participated in the development of the study design, interpretation of data, review, development, and approval of the publication.

    View full text