a Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel.
b Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK.
Expert Rev Gastroenterol Hepatol. 2017 Nov;11(11):1047-1058. doi: 10.1080/17474124.2017.1359541. Epub 2017 Jul 30.
In recent years, the therapeutic paradigm in Crohn's disease has shifted from a mere symptom-oriented approach, to aiming to healing of the underlying inflammation and prevention of long-term structural complications. Such 'treat-to-target' approach may allow for a more stable disease course with less hospitalizations, lower requirement for surgery and improved quality of life. In Crohn's disease, the small bowel is affected in the majority of patients; frequently, Crohn's involves only the small bowel, which remains inaccessible to conventional ileocolonoscopic techniques. Thus, non-invasive monitoring techniques are crucial for accurate disease assessment. Areas covered: This review addresses the indications and clinical implications of non-invasive small bowel monitoring modalities (magnetic resonance enterography, intestinal ultrasound, capsule endoscopy) in the assessment and management of Crohn's disease. Expert commentary: This review addresses the limitations of the current knowledge and future areas of research, including the possible utilization of transmural healing as an imaging target and the need to establish clear quantitative target values to guide treatment by imaging findings in Crohn's disease.
近年来，克罗恩病的治疗模式已从单纯的对症治疗转变为旨在治愈潜在炎症和预防长期结构并发症。这种“靶向治疗”方法可能使疾病更稳定，住院次数更少，手术需求更低，生活质量更高。在克罗恩病中，小肠受到影响的患者占多数；通常，克罗恩病只影响小肠，而传统的回结肠镜技术无法触及小肠。因此，非侵入性监测技术对于准确评估疾病至关重要。涵盖领域：本文综述了非侵入性小肠监测方法（磁共振肠造影术、肠超声、胶囊内镜）在克罗恩病评估和管理中的适应证和临床意义。专家评论：本文综述了目前知识的局限性和未来研究领域，包括将透壁愈合作为成像靶点的可能性，以及需要确定明确的定量目标值，以根据成像结果指导克罗恩病的治疗。
