Background: Crohn's disease (CD) management targets mucosal healing on ileocolonoscopy as a treatment goal. We hypothesized that ultrasonographic response is also associated with better long-term outcomes.
Methods: Patients with CD treated with anti TNF agents who had serial small intestine contrast ultrasonography (SICUS) between January 2011 and October 2016 were identified. Disease site (based on bowel wall thickness), extent of lesions, and presence of complications (stenosis, prestenotic dilation, abscess, or fistulas) were evaluated using SICUS. Inclusion required pre-therapy SICUS with follow-up SICUS after 12 months, or 2 SICUS≥12 months apart while on maintenance therapy. At second SICUS, complete responders had all improved lesions, non-responders had worsening or new lesions, and partial responders had other scenarios. CD-related outcomes of corticosteroid need, hospitalization, and surgery were assessed at one year from the second SICUS.
Results: Seventy CD patients treated with anti-TNF alpha therapy (36% with Infliximab, 64% with Adalimumab) were identified. Most patients had ileal disease (67%) and stricturing phenotype (54%). Based on SICUS, thirty-five patients (50%) were complete sonographic responders, 24 partial (34%), and 11 non-responders (16%). Complete and partial responders at SICUS had a reduced risk for surgery in comparison with non responders [p=0.012 (0.11, CI: 0.021–0.60), p=0.04 (OR 0.17, CI: 0.031–0.93)]. Complete responders at SICUS had a reduced risk for need for rescue corticosteroids in comparison with non responders [p=0.012 (OR 0.17, CI: 0.031–0.93)].
Conclusions: Ultrasonographic response to medical therapy is associated with significant reductions in long-term risk of surgery and steroid usage among CD patients. These findings suggest the significance of response assessed by ultrasonography as a treatment target.