Background: Crohn's disease (CD) is a chronic transmural inflammatory condition usually involving the small bowel. While endoscopic mucosal healing is the currently accepted therapy target, in most patients and adequate evaluation of the small bowel is not possible. Magnetic resonance enterography (MRE) is a noninvasive modality commonly performed to assess the small bowel in CD. However, long-term outcomes associated with MRE improvement are still to be assessed. The purpose of this study was to determine whether MRE remission predicts long-term outcomes in patients with CD.
Methods: Using a prospectively maintained database of patients with inflammatory bowel disease, we retrospectively analyzed patients with CD restricted to the small bowel, and with MRE examinations. Outcomes included surgery and need to start or change immunosuppressive therapy.
Results: We included 246 patients, median age at MRE examination of 37.0 (8–78) years. The median time from diagnosis to MRE was 7 (0–40) years with a median follow-up of 4 (1–9) years following MRE. MRE showed active inflammation in 175 studies (71.1%). Patients demonstrating MRE-active inflammation were more likely to require a change in anti-TNF (45.3% versus 18.3%, p<0.001), thiopurines (34.1% versus 14.9%, p=0.002), any medication (60.0% versus 26.8%, p<0.001), and also more likely to undergo surgery (18.9% versus 2.8%, p<0.001). A compound unfavorable outcome including change in medication or surgery was also more likely in patients with active MRE (65.1% versus 28.2%, p<0.000). In logistic regression analysis, MRE-activity (OR 5.85 95% CI 1.32–25.91, p=0.02) and the presence of a stricture (OR 2.75 95% CI 1.24–6.12, p=0.01) were independentely associated with surgery.
Conclusions: In this study, MRE remission was associated with significantly improved long-term outcomes. Obtaining MRE remission may be a potential therapy target in patients with CD.