Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Abstract

Summary Background In Crohn's disease, it is essential to distinguish between persistent damage and abnormalities that can heal with anti‐inflammatory therapy. Aim To assess magnetic resonance enterography (MRE) lesions that persist in patients in long‐standing endoscopic remission, analyse their relationship with baseline characteristics, and determine their prognostic implications. Methods We systematically reviewed pre‐ and post‐treatment MRE findings in patients with Crohn's disease and severe inflammation (segmental CDEIS ≥ 7 or ulcers in at least one segment) who achieved endoscopic remission (CDEIS < 2) after 1 year of treatment with TNF‐inhibitors or autologous haematopoietic stem‐cell transplantation. Logistic regression analysis was used to identify predictors of persistent abnormalities. Results Endoscopic remission was achieved in 73 intestinal segments in 28 patients (69% females; 9.95 years disease duration, 67.9% inflammatory phenotype; 39.3% ileal location). Creeping fat and intestinal wall fat deposits were unchanged on pre‐ and post‐treatment MRE despite the endoscopic remission. Luminal strictures persisted in 6 out of the 8 segments with baseline strictures, and wall thickening in 23 out of the 72 of segments with thickening at baseline. Predictors of persistent mural thickening were pre‐treatment wall thickness > 5.9 mm (OR = 4.38, P = 0.027) and refractory disease prior to baseline (OR = 2.35, P = 0.001). Creeping fat was the only predictor for persistence of creeping fat (OR = 36.43, P < 0.001). Persistence of strictures at MRE is associated with earlier recurrence (P = 0.014). Conclusions Persistent MRE abnormalities are frequent in patients with Crohn's disease despite achieving endoscopic remission. Significant wall thickening, intestinal fat deposition, strictures, and creeping fat at baseline MRE are signs of established damage.

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

“…Patients receiving escalated dosages of anti-TNFs or for the indication of postoperative recurrence in Crohn’s disease had a >75% risk of relapse on drug withdrawal. Persistent abnormalities on MRE in Crohn’s disease patients in endoscopic remission also makes relapse more likely 851. Decisions regarding withdrawal should be taken in the context of the individual patient, their disease history and the consequences of relapse 852…”

Whole transcriptional analysis identifies markers of B, T and plasma cell signaling pathways in the mesenteric adipose tissue associated with Crohn’s disease

“…Altered MAT near the affected intestinal area is considered to be characteristic of severe CD [6,[27][28][29][30]. Persistent alterations in this tissue even after endoscopic remission can be observed by magnetic resonance imaging [31], and may be associated with a complicated disease course and abdominal surgery in CD [32]. There is now more evidence to link intestinal and mesenteric abnormalities in CD, and this knowledge may influence clinical and surgical management of this disease.…”

Differences in the imaging of Crohn’s disease patients between North America and Europe: are we ready to bridge the divide?

“…Complete response to therapy as shown by resolution of all imaging findings of inflammation at US, CT and MR enterography is termed "transmural healing", as these cross-sectional techniques image the bowel wall. Of note, abnormalities on crosssectional imaging, such as wall thickening, strictures and creeping fat, frequently persist, despite achieving endoscopic remission [32]. MR enterography has an approximately 90% accuracy for mucosal healing [33], and other studies have demonstrated improved outcomes or prediction of clinical remission with transmural healing [34,35].…”