Predicting future disease course in Crohn's disease by colonoscopy or magnetic resonance: which is the crystal ball?

Crohn's disease (CD) is a chronic and progressive condition leading to cumulative bowel damage overtime, mainly related to stricturing or penetrating lesions. About half of patients with CD require surgical intestinal resection 10 years after diagnosis.1 Importantly, the development of disease complications (stricture, fistula and/or abscess) is known to be the main indication for surgery in these patients.1 The identification of factors associated with a higher need for surgery for CD is a prerequisite to the development of therapeutic strategies potentially altering disease course, with the final aim of preventing undertreatment and avoiding overtreatment with biologics. Clinical risk factors are insufficient to predict disease course,2 and there is a well-known disconnect between clinical symptoms and endoscopic disease activity.3 Hence, we need to look beyond clinical symptoms. Accumulating evidence indicates that mucosal healing may change the natural course of the disease by decreasing...
Source: Gut - Category: Gastroenterology Authors: Tags: Commentary Source Type: research

Related Links:

The objective of this study was to assess if bowel wall iodine density obtained from dual-source, dual-energy computed tomography enterography (DECTE) could be a biomarker of Crohn's disease activity. Methods Twenty-two patients with Crohn's disease imaged with DECTE from February 2016 to May 2018 were retrospectively identified by departmental report search. Iodine maps were created with commercial software (Syngovia). Iodine content was normalized to the aorta, and then manual dual-energy region-of-interest cursors were placed over the visibly assessed maximal and minimal iodine density within segments of involved as ...
Source: Journal of Computer Assisted Tomography - Category: Radiology Tags: Abdominal Imaging Source Type: research
Abstract BACKGROUND: Emergency situations in inflammatory bowel diseases (IBD) put significant burden on both the patient and the healthcare system. AIM: To prospectively measure Quality-of-Care indicators and resource utilization after the implementation of the new rapid access clinic service (RAC) at a tertiary IBD center. METHODS: Patient access, resource utilization and outcome parameters were collected from consecutive patients contacting the RAC between July 2017 and March 2019 in this observational study. For comparing resource utilization and healthcare costs, emergency department (ED) visits of ...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Condition:   Crohn Disease Interventions:   Diagnostic Test: PillCamTM Crohn's capsule;   Diagnostic Test: Magnetic resonance enterography;   Procedure: Ileo-colonoscopy Sponsors:   South Tyneside and Sunderland NHS Foundation Trust;   County Durham and Darlington NHS Foundation Trust;   Sheffield Teaching Hospitals NHS Foundation Trust;   Newcastle University;   Durham University Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
The present study aimed to investigate the potential use of T2-weighted sequences with diffusion weighted imaging (DWI) in magnetic resonance (MR) enterography instead of conventional contrast-enhanced MR imaging (MRI) sequences for the evaluation of active inflammation in Crohn disease. Two-hundred thirteen intestinal segments of 43 patients, who underwent colonoscopy within 2 weeks before or after MR enterography were evaluated in this retrospective study. DWI sequences, T2-weighted sequences, and contrast-enhanced T1-weighted sequences were acquired in the MR enterography scan after cleaning of the bowel and using an o...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Diagnostic Accuracy Study Source Type: research
Patients with Crohn ’s disease (CD) who undergo a first surgery are at higher risk of having a subsequent surgery in light of recurrence of disease. Significant evidence suggests that a postoperative colonoscopy evaluating recurrence at the anastomosis using the Rugeerts score (RS) can predict risk of repeat surgery. Given the invasive nature of colonoscopy, there has been increasing interest in using noninvasive biomarkers to predict disease recurrence. Studies have shown variability in the operating characteristics of the fecal calprotectin (FC) assay with sensitivities and specificities for detecting recurre nce r...
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Disease Activity Assessment Source Type: research
Faecal calprotectin (FC) is a biomarker elevated in active inflammatory bowel disease (IBD). FC is more sensitive in colonic than small bowel IBD. Ileo-colonoscopy is usually performed to confirm a diagnosis of IBD. Isolated non-specific terminal ileitis is often inconclusive despite biopsy. We aimed to assess the factors that predict terminal ileal Crohn's disease after ileitis is seen at colonoscopy.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Diagnostics in IBD Source Type: research
Inflammatory Bowel Disease (IBD) patients have frequent complications after surgical procedures. Inflammation, immunosuppression and other factors that are more common in Crohn ’s disease (CD) and ulcerative colitis (UC) may play a role in increasing their complication risk profile. IBD patients also undergo colonoscopy procedures more frequently than the general population. We aimed to identify risks of complications during or within 7 days of colonoscopy in IBD patient s.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Epidemiology Source Type: research
The subtype of inflammatory bowel disease (IBD) is often not known at index colonoscopy and examining for perianal disease (PAD) can assist in establishing the diagnosis. PAD is common in Crohn ’s disease (CD) but can also be seen in patients with ulcerative colitis (UC) in the form of fissures, abscesses and fistulae. Absence of perianal symptoms does not exclude PAD. Performing a routine perianal examination in a busy outpatient setting is not ideal and the endoscopy suite may be more appropriate.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Disease Activity Assessment Source Type: research
Surveillance for colorectal cancer (CRC) is necessary in patients with inflammatory bowel disease (IBD). Patients with ulcerative colitis (UC) have a similar CRC risk to those with Crohn ’s colitis (CC). British Society of Gastroenterology (BSG) guidelines from 2010 outlined recommendations for screening including surveillance intervals and pancolonic dye spraying with targeted biopsies. We aimed to identify reasons why the first surveillance colonoscopy is not being performed as advised, including the role of poor bowel preparation and disease activity.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Practice Management/Quality of Care/Quality Assurance Source Type: research
Rationale: Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (LPD) usually occurs in children and young adults. Gastrointestinal involvement is rare. EBV-associated T-cell lymphoproliferative disorder manifesting as intestinal ulcers poses diagnostic challenges clinically and pathologically because of the atypical manifestations. We concluded that some indicators according to our case and literatures, which might be helpful to the diagnosis of EBV-associated LPD manifested as intestinal ulcers. Patient concerns: Here we present a 26-year-old man with complaints of diarrhea and abdominal pain that...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
More News: Colonoscopy | Crohn's Disease | Gastroenterology | Inflammatory Bowel Disease