University Hospital of Kiel, 1st Medical Department, Arnold Heller Str. 9, 24105 Kiel, Germany.
Private Practice for Internal Medicine, Department of Gastroenterology, Neue Donnerschweer Str. 30, 26123 Oldenburg, Germany.
J Crohns Colitis. 2022 Jan 28;16(1):57-67. doi: 10.1093/ecco-jcc/jjab106.
Intestinal ultrasound [IUS] is a useful modality to monitor patients with inflammatory bowel disease [IBD]. Little is known about the use of IUS and appropriate definitions for transmural response [TR] and healing [TH]. We aimed to establish the use of IUS in monitoring TH as a potential target in routine medical practice.
Based on the prospective, non-interventional, multicentre studies TRUST and TRUST&UC, we conducted a post-hoc analysis of 351 IBD patients with increased bowel wall thickness [BWT]. We analysed the rates of patients achieving TR and TH, comparing three definitions of TH. In 137 Crohn's disease [CD] patients, the predictive value of TR and TH was investigated for the clinical and sonographic outcome at week 52.
Within 12 weeks of treatment intensification, 65.6% [n = 118] of CD patients and 76.6% [n = 131] of ulcerative colitis [UC] patients showed a TR. Depending on the definition, 23.9-37.2% [n = 58/67/43] of CD patients and 45.0-61.4% [n = 90/105/77] of UC patients had TH at week 12. CD patients with TH were more likely to reach clinical remission at week 12 (odds ratio [OR] 3.33 [1.09-10.2]; p = 0.044) and a favourable sonographic outcome (OR 5.59 [1.97-15.8]; p = 0.001) at week 52 compared with patients without TH.
IUS response and TH in a relevant proportion of patients suggests that IUS is a useful method to assess transmural inflammatory activity in daily clinical practice. TR and TH are predictive for the sonographic outcome at week 52.
肠超声[IUS]是一种监测炎症性肠病[IBD]患者的有用手段。对于 IUS 的应用以及透壁反应[TR]和愈合[TH]的适当定义知之甚少。我们旨在确定 IUS 在监测 TH 中的应用,作为常规医疗实践中的一个潜在目标。
基于前瞻性、非干预性、多中心研究 TRUST 和 TRUST&UC,我们对 351 例肠壁增厚[BWT]增加的 IBD 患者进行了一项事后分析。我们分析了三种 TH 定义下达到 TR 和 TH 的患者比例。在 137 例克罗恩病[CD]患者中,我们研究了 TR 和 TH 的预测价值,以评估第 52 周的临床和超声结果。
在强化治疗的 12 周内,65.6%[n=118]的 CD 患者和 76.6%[n=131]的溃疡性结肠炎[UC]患者出现 TR。根据定义,23.9-37.2%[n=58/67/43]的 CD 患者和 45.0-61.4%[n=90/105/77]的 UC 患者在第 12 周时出现 TH。在第 12 周时,达到 TH 的 CD 患者更有可能达到临床缓解(比值比[OR]3.33[1.09-10.2];p=0.044),并且在第 52 周时出现有利的超声结果(OR 5.59[1.97-15.8];p=0.001),与没有 TH 的患者相比。
在相当一部分患者中,IUS 反应和 TH 表明 IUS 是一种在日常临床实践中评估透壁炎症活动的有用方法。TR 和 TH 可预测第 52 周的超声结果。