Department of Gastroenterology and Hepatology, Internal Medicine, School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan.
Am J Gastroenterol. 2018 Feb;113(2):283-294. doi: 10.1038/ajg.2017.464. Epub 2017 Dec 19.
Small bowel (SB) endoscopic healing has not been well studied in patients with Crohn's disease (CD). This study aims to evaluate the utility of magnetic resonance (MR) enterography (MRE) for SB lesions in comparison with balloon-assisted enteroscopy (BAE) findings.
In total, 139 patients with CD in clinical-serological remission were prospectively followed after BAE and MRE procedures. We applied a modified version of the Simple Endoscopic Score for CD (SES-CD) for an endoscopic evaluation of the SB, called the Simple Endoscopic Active Score for CD (SES-CDa). We also used the MR index of activity (MaRIA) for MR evaluations. The primary end points were time to clinical relapse (CD activity index of >150 with an increase of >70 points) and serological relapse (abnormal elevation of C-reactive protein).
Clinical and serological relapses occurred in 30 (21.6%) and 62 (44.6%) patients, respectively. SB endoscopic healing (SES-CDa<5) was observed in 76 (54.7%) patients. A multiple regression analysis showed that the lack of SB endoscopic healing was an independent risk factor for clinical relapses (hazard ratio (HR): 5.34; 95% confidence interval (CI): 2.06-13.81) and serological relapses (HR: 3.02; 95% CI: 1.65-5.51), respectively. MR ulcer healing (MaRIA score <11) demonstrated a high diagnostic accuracy (90.9%; 95% CI: 87.9-93.2%) for endoscopic healing. The kappa coefficient between BAE and MRE for longitudinal responsiveness was 0.754 (95% CI: 0.658-0.850) for clinical relapse and 0.783 (95% CI: 0.701-0.865) for serological relapse.
SB inflammation was associated with a poor prognosis in patients with clinical-serological remission. MRE is a valid and reliable examination for SB inflammatory activity both for cross-sectional evaluations and prognostic prediction.
小肠（SB）内镜愈合在克罗恩病（CD）患者中尚未得到很好的研究。本研究旨在评估磁共振（MR）肠造影术（MRE）在评估 SB 病变方面的效用，与气囊辅助内镜检查（BAE）结果进行比较。
总共前瞻性随访了 139 例临床血清学缓解的 CD 患者，在 BAE 和 MRE 后进行了检查。我们对 SB 进行了内镜评估，应用了一种改良的简单 CD 内镜评分（SES-CD），称为简单 CD 活动评分（SES-CDa）。我们还使用了活动的 MR 指数（MaRIA）进行 MR 评估。主要终点是临床复发（CD 活动指数>150，增加>70 分）和血清学复发（C 反应蛋白异常升高）的时间。
30 例（21.6%）和 62 例（44.6%）患者分别出现临床和血清学复发。76 例（54.7%）患者出现 SB 内镜愈合（SES-CDa<5）。多因素回归分析显示，SB 内镜愈合不良是临床复发（危险比（HR）：5.34；95%置信区间（CI）：2.06-13.81）和血清学复发（HR：3.02；95% CI：1.65-5.51）的独立危险因素。MR 溃疡愈合（MaRIA 评分<11）对内镜愈合具有较高的诊断准确性（90.9%；95%CI：87.9-93.2%）。BAE 和 MRE 之间在纵向反应性方面的kappa 系数分别为 0.754（95%CI：0.658-0.850）和 0.783（95%CI：0.701-0.865），用于临床复发和血清学复发。
SB 炎症与临床血清学缓解患者的不良预后相关。MRE 是一种有效的、可靠的 SB 炎症活动检查方法，无论是用于横断面评估还是预后预测。
