Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome.
Gastroenterology, Department of Clinical Medicine and Surgery, Federico II, School of Medicine, Naples.
Clin Gastroenterol Hepatol. 2022 Apr;20(4):e711-e722. doi: 10.1016/j.cgh.2021.03.030. Epub 2021 Mar 26.
BACKGROUND & AIMS: Bowel ultrasonography (BUS) is a noninvasive tool for evaluating bowel activity in Crohn's disease (CD) patients. Aim of our multicenter study was to assess whether BUS helps to monitor intestinal activity improvement/resolution following different biological therapies.
Adult CD patients were prospectively enrolled at 16 sites in Italy. Changes in BUS parameters [i.e. bowel wall thickening (BWT), lesion length, echo pattern, blood flow changes and transmural healing (TH: normalization of all BUS parameters)] were analyzed at baseline and after 3, 6 and 12 months of different biological therapies.
One hundred eighty-eight out of 201 CD patients were enrolled and analyzed (116 males [62%]; median age 36 years). Fifty-five percent of patients were treated with adalimumab, 16% with infliximab, 13% with vedolizumab and 16% with ustekinumab. TH rates at 12 months were 27.5% with an NNT of 3.6. TH at 12 months after adalimumab was 26.8%, 37% after infliximab, 27.2% after vedolizumab and 20% after ustekinumab. Mean BWT improvement from baseline was statistically significant at 3 and 12 months (P < .0001). Median Harvey-Bradshaw index, C-reactive protein and fecal calprotectin decreased after 12 months from baseline (P < .0001). Logistic regression analysis showed colonic lesion was associated with a higher risk of TH at 3 months and a greater BWT at baseline was associated with a lower risk of TH at 3 months [P = .03 (OR 0.70, 95% CI 0.50-0.97)] and 12 months [P = .01 (OR 0.58, 95% CI 0.38-0.89)]. At 3 months therapy optimization during the study was the only independent factor associated with a higher risk of no ultrasonographic response [P = .02 (OR 3.34, 95% CI 1.18-9.47)] and at 12 months disease duration [P = .02 (OR 3.03, 95% CI 1.15-7.94)].
Data indicate that BUS is useful to monitor biologics-induced bowel activity improvement/resolution in CD.
肠道超声（BUS）是一种非侵入性工具，可用于评估克罗恩病（CD）患者的肠道活动。本多中心研究的目的是评估 BUS 是否有助于监测不同生物治疗后肠道活动的改善/缓解。
在意大利的 16 个地点前瞻性纳入成年 CD 患者。在基线时和不同生物治疗后 3、6 和 12 个月，分析 BUS 参数的变化[即肠壁增厚（BWT）、病变长度、回声模式、血流变化和透壁愈合（TH：所有 BUS 参数的正常化）]。
201 名 CD 患者中有 188 名（男性 116 名[62%]；中位年龄 36 岁）入组并进行了分析。55%的患者接受阿达木单抗治疗，16%的患者接受英夫利昔单抗治疗，13%的患者接受维得利珠单抗治疗，16%的患者接受乌司奴单抗治疗。12 个月时的 TH 率为 27.5%，NNT 为 3.6。阿达木单抗治疗后 12 个月的 TH 率为 26.8%，英夫利昔单抗为 37%，维得利珠单抗为 27.2%，乌司奴单抗为 20%。与基线相比，3 个月和 12 个月时 BWT 的平均改善具有统计学意义（P<.0001）。基线后 12 个月，Harvey-Bradshaw 指数、C 反应蛋白和粪便钙卫蛋白中位数降低（P<.0001）。逻辑回归分析显示，结肠病变与 3 个月时 TH 的风险增加相关，而基线时更大的 BWT 与 3 个月（P=.03，OR 0.70，95%CI 0.50-0.97）和 12 个月（P=.01，OR 0.58，95%CI 0.38-0.89）时 TH 的风险降低相关。在 3 个月时，研究期间的治疗优化是与超声无反应风险增加相关的唯一独立因素（P=.02，OR 3.34，95%CI 1.18-9.47），而在 12 个月时，疾病持续时间（P=.02，OR 3.03，95%CI 1.15-7.94）。
数据表明，BUS 可用于监测 CD 患者生物制剂诱导的肠道活动改善/缓解。
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