Assessment of Crohn’s disease activity by Doppler sonography

Ying, Nie; Zhou, Jian; Xiao, Xiang-Min; Zhang, Wenxing; Honglei, Gao; Wang, Yan; Han, Xiaoyan; Sun, Zuocheng; Xu, Hong

doi:10.15537/smj.2017.4.17855

Cited by 5 publications

(5 citation statements)

References 29 publications

(32 reference statements)

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“…Therefore, the thickness of the intestinal wall together with the vascular pattern may be useful for detecting the endoscopic activity of the disease [ 34 ]. Other studies that assessed the superior mesenteric artery flow as a semi-quantitative parameter confirmed the previous observations regarding the correlation between the severity of the disease and Doppler parameters [ 35 , 36 ].…”

Section: Resultssupporting

confidence: 82%

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

et al. 2021

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Crohn’s disease is characterized by persistent or recurrent chronic inflammation that may affect any segment of the gastrointestinal tract. It has an oscillating evolution, with periods of activity alternating with periods of remission. Crohn’s disease has a significant impact on the economic status due to its increasing prevalence, often affecting young people. Suitable management for these patients involves frequent evaluations. Even though colonoscopy is the gold standard for the assessment of severity and mucosal healing, it is an invasive maneuver, not easily accepted by patients, and it does not have good repeatability. Intestinal ultrasound has the advantage of being non-irradiating, non-invasive, well-tolerated, cheap, and easy to repeat. Ultrasound parameters such as bowel wall thickness, intestinal wall architecture, intramural vascularisation, proliferation of mesenteric fatty conjunctive tissue, and intraperitoneal fluid can provide good information regarding the severity of the disease, the differentiation between remission and relapse, and its complications. Some of the latest studies show good correlations between ultrasound parameters and inflammation markers (C-reactive protein, fecal calprotectin) and clinical severity scores of Crohn’s disease. Consequently, the importance of intestinal ultrasound has increased lately, and recent studies support its use to evaluate the severity of inflammation, differentiate between active disease and relapse, monitor therapy response and guide treatment, evaluate prognosis, and diagnose complications.

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Section: Resultssupporting

confidence: 82%

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

et al. 2021

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“…The data of our study showed that the difference of BWT between active and inactive group was statistically significant. In this study, the median BWT in active and inactive group was 8.04 ± 3.32 mm and 6.75 ± 2.51 mm, respectively, larger than that was previously reported [27][28][29] . This could be associated with a longer course of the disease in our www.nature.com/scientificreports/ study (average course of disease was about 45 months), and pathological examination showed that severe inflammation accounted for 37.2% in our cases.…”

Section: Discussioncontrasting

confidence: 70%

The establishment of a regression model from four modes of ultrasound to predict the activity of Crohn's disease

Jing

et al. 2021

Sci Rep

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To establish a multi-parametric regression model from four modes of ultrasound to predict the activity of Crohn's disease (CD) noninvasively. Score of 150 of the Crohn’s Disease Activity Index (CDAI) was taken as the cut-off value to divide the involved bowel segments of 51 patients into the active and inactive group. Eleven parameters from four modes of ultrasound (B-mode ultrasonography, color Doppler flow imaging, contrast-enhanced ultrasonography and shear wave elastography) were compared between the two groups to investigate the relationship between multimodal ultrasonic features and CD activity. P < 0.05 was considered statistically significant. Parameters with AUC larger than 0.5 was selected to establish the prediction model of CDAI. Totally seven ultrasound parameters (bowel wall thickness, mesenteric fat thickness, peristalsis, texture of enhancement, Limberg grade, bowel wall perforation and bowel wall stratification) were significantly different between active and inactive group. A regression model was established based on the seven parameters as followed: CDAI = 211.325 + 3.186BWT − 53.003BWS + 6.280BWP + 0.392MFT + 22.239PS + 79.012LG + 72.793TE. (R2 = 0.72, P = 0.037). The multimodal ultrasound parametric regression model was designed to predict CDAI score invasively. The model has the potential to provide an alternative method for quantifying the CD activity.

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“…Other changes encountered by the intestine due to inflammation in CD that might affect the PK of oral drugs are reported. These include dilation of the blood vessels [ 78 , 89 ], change of the intestine vascularity [ 90 – 92 ], change of intestine blood perfusion [ 90 – 94 ], increase in the thickness of the intestine wall (active CD > 4 mm) [ 78 , 80 , 81 , 83 , 89 , 93 ], submucosal fibrosis and muscularisation [ 91 ] and wrapping of the intestinal wall in fat wrap [ 95 ], but they are beyond the focus of this analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Although an increase of gut wall thickness can affect gut fluid dynamics, a meta-analysis was not carried out for this parameter even though it showed an approximately twofold increase in active CD patients compared to healthy volunteers in the few studies encountered [ 78 , 80 , 81 , 93 , 158 ]. This is because the utility of the intestine loop morphology is not clear in the Simcyp ® M-ADAM model; instead, the villous morphology is established in Simcyp ® .…”

Section: Discussionmentioning

confidence: 99%

Altered Bioavailability and Pharmacokinetics in Crohn’s Disease: Capturing Systems Parameters for PBPK to Assist with Predicting the Fate of Orally Administered Drugs

Alrubia

Mao²,

Chen³

et al. 2022

Clin Pharmacokinet

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Backgrond and Objective Crohn’s disease (CD) is a chronic inflammatory bowel disease that affects a wide age range. Hence, CD patients receive a variety of drugs over their life beyond those used for CD itself. The changes to the integrity of the intestine and its drug metabolising enzymes and transporters (DMETs) can alter the oral bioavailability of drugs. However, there are other changes in systems parameters determining the fate of drugs in CD, and understanding these is essential for dose adjustment in patients with CD. Methods The current analysis gathered all the available clinical data on the kinetics of drugs in CD (by March 2021), focusing on orally administered small molecule drugs. A meta-analysis of the systems parameters affecting oral drug pharmacokinetics was conducted. The systems information gathered on intestine, liver and blood proteins and other physiological parameters was incorporated into a physiologically based pharmacokinetic (PBPK) platform to create a virtual population of CD patients, with a view for guiding dose adjustment in the absence of clinical data in CD. Results There were no uniform trends in the reported changes in reported oral bioavailability. The nature of the drug as well as the formulation affected the direction and magnitude of variation in kinetics in CD patients relative to healthy volunteers. Even for the same drug, the reported changes in exposure varied, possibly due to a lack of distinction between the activity states of CD. The highest alteration was seen with S -verapamil and midazolam, 8.7- and 5.3-fold greater exposure, respectively, in active CD patients relative to healthy volunteers. Only one report was available on liver DMETs in CD, and indicated reduced CYP3A4 activity. In a number of reports, mRNA expression of DMETs in the ileum and colon of CD patients was measured, focussing on P-glycoprotein (p-gp) transporter and CYP3A4 enzyme, and showed contradictory results. No data were available on protein expression in duodenum and jejunum despite their dominant role in oral drug absorption. Conclusion There are currently inadequate dedicated clinical or quantitative proteomic studies in CD to enable predictive PBPK models with high confidence and adequate verification. The PBPK models for CD with the available systems parameters were able to capture the major physiological influencers and the gaps to be filled by future research. Quantification of DMETs in the intestine and the liver in CD is warranted, alongside well-defined clinical drug disposition studies with a number of index drugs as biomarkers of changes in DMETs in these patients, to avoid large-scale dedicated studies for every drug to determine the effects of disease on the drug’s metabolism and disposition and the consequential safety and therapeutic concerns. Supplementary Information The online version contains supplementary material av...

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Assessment of Crohn’s disease activity by Doppler sonography

Cited by 5 publications

References 29 publications

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

The establishment of a regression model from four modes of ultrasound to predict the activity of Crohn's disease

Altered Bioavailability and Pharmacokinetics in Crohn’s Disease: Capturing Systems Parameters for PBPK to Assist with Predicting the Fate of Orally Administered Drugs

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