Silent Crohnʼs Disease Predicts Increased Bowel Damage During Multiyear Follow-up

Bhattacharya, Abhik; Rao, Bhavana Bhagya; Koutroubakis, Ioannis Ε.; Click, Benjamin; Vargas, Eric J.; Regueiro, Miguel; Schwartz, Marc; Swoger, Jason M.; Babichenko, Dmitriy; Hartmann, Douglas; Rivers, Claudia Ramos; Barrie, Arthur; Hashash, Jana G.; Dunn, Michael A.; Binion, David G.

doi:10.1097/mib.0000000000000935

Cited by 30 publications

(26 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found that hypoalgesic CD patients were at increased risk of developing IBD-associated complications (e.g., fistulae). Each of these findings was comparable to what has been reported in other studies that attempted to evaluate silent IBD [6][7][8]10]. These results reinforce the clinical relevance of hypoalgesic IBD and the importance of improving our understanding of this condition.…”

Section: Discussionsupporting

confidence: 87%

“…If IBD patients with clinically significant disease activity do not simultaneously experience and/or report symptoms commensurate with the degree of inflammation, including abdominal pain, they are described as having silent IBD. Silent IBD is important because it has been associated with the development of more frequent and serious complications, including strictures, fistulae, and abscesses [6,7], as well as increased hospitalization [8]. As abdominal pain is one of the most frequently described and consequential symptoms in the setting of IBD [9], it is not difficult to imagine that a lack of or reduction in abdominal pain by itself during periods of significant disease activity, or "hypoalgesic IBD", can impart a tremendous risk of poor outcomes over time.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gastrointestinal hypoalgesia in inflammatory bowel disease

Coates¹,

Soriano²,

Dalessio³

et al. 2019

aog

View full text Add to dashboard Cite

Background Pain perception is critical for detection of noxious bodily insults. Gastrointestinal hypoalgesia in inflammatory bowel disease (IBD) is a poorly understood phenomenon previously linked to poor patient outcomes. We aimed to evaluate the risk factors associated with this condition and to discern characteristics that might differentiate these patients from pain-free quiescent counterparts. Methods We performed a retrospective analysis using an IBD natural history registry based in a single tertiary care referral center. We compared demographic and clinical features in 3 patient cohorts defined using data from simultaneous pain surveys and ileocolonoscopy: a) active IBD without pain (hypoalgesic IBD); b) active IBD with pain; and c) inactive IBD without pain. Results One hundred fifty-three IBD patients had active disease and 43 (28.1%) exhibited hypoalgesia. Hypoalgesic IBD patients were more likely to develop non-perianal fistulae (P=0.03). On logistic regression analysis, hypoalgesic IBD was independently associated with male sex, advancing age and mesalamine use, and inversely associated with anxious/depressed state and opiate use. Hypoalgesic IBD patients were demographically and clinically similar to the painfree quiescent IBD cohort (n=59). Platelet count and C-reactive protein were more likely to be pathologically elevated in hypoalgesic IBD (P=0.03), though >25% did not exhibit elevated inflammatory markers. Conclusions Hypoalgesia is common in IBD, particularly in male and older individuals, and is associated with an increased incidence of fistulae and corticosteroid use. Novel noninvasive diagnostic tools are needed to screen for this population, as inflammatory markers are not always elevated.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Gastrointestinal hypoalgesia in inflammatory bowel disease

Coates¹,

Soriano²,

Dalessio³

et al. 2019

aog

View full text Add to dashboard Cite

show abstract

“…They found neither endoscopic activity nor inflammatory biomarkers (CRP or fecal protection) to be correlated with damage progression. In contrast to their results Bhattacharya and colleagues 67 found CRP to correlate to damage progression in quiescent CD.…”

Section: Clinical Implications Of Mre Indicescontrasting

confidence: 79%

A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation

Rozendorn

Amitai

Eliakim

et al. 2018

Therap Adv Gastroenterol

View full text Add to dashboard Cite

Magnetic resonance enterography (MRE) is a leading radiological modality in Crohn’s disease (CD) and is used together with laboratory findings and endoscopic examinations for the evaluation of patients during initial diagnosis and follow up. Over the years, there has been great progress in the understanding of CD and there is a continuous strive to achieve better monitoring of patients and to develop new modalities which will predict disease course and thus help in clinical decisions making. An objective evaluation of CD using a quantification score is not a new concept and there are different clinical, endoscopies, radiological and combined indices which are used in clinical practice. Such scores are a necessity in clinical trials on CD for evaluation of disease response, however, there is no consensus of the preferred MRE score and they are not routinely used. This review presents MRE-based indices in use in the last decade: the Magnetic Resonance Index of Activity (MaRIA), the Clermont score, the Crohn’s Disease Magnetic Resonance Imaging (MRI) Index (CDMI), the Magnetic Resonance Enterography Global Score (MEGS) and the Lemann index. We compare the different indices and evaluate the clinical research that utilized them. The aim of this review is to provide a reference guide for researchers and clinicians who incorporate MRE indices in their work. When devising future indices, accumulated data of the existing indices must be taken into account, as each of the current indices has its own strengths and weakness.

show abstract

“…The same group also demonstrated by using the Lémann Index that elevated CRP is independently associated with 7-fold greater worsening of the disease trajectory (OR, 6.93; 95% CI, 2.44-19.67) compared with a stable disease trajectory. 14,15 In my opinion, however, asymptomatic "Silent CD" with CRP elevation is not actually "Silent CD" because the increase in CRP, which is commonly measured in daily clinical practice, alerts the physician (especially IBD specialists) to the presence of an active lesion. We should be aware of "Real Silent CD" in which CRP levels are not elevated.…”

Section: Features Of Sb Lesions In Patients With CDmentioning

confidence: 98%

Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

Watanabe

2020

Intest Res

View full text Add to dashboard Cite

A treat-to-target strategy, in which treatment is continuously adjusted according to the results of scheduled objective monitoring, is optimal for patients with Crohn’s disease (CD) in the era of biologics. The small bowel is a common site of intractable CD, which may result from multiple strictures or expanding lesions. To improve the prognosis of patients with small bowel CD, lesions should be proactively monitored within the subclinical phase. Objective assessment of small bowel lesions is technically difficult, however, due to the relatively poor correlation between endoscopic activity and clinical symptoms or biomarker titers. The presence of proximal small bowel lesions and asymptomatic “Real Silent CD” must be considered. Endoscopy remains the gold standard to assess these lesions. In clinical practice, the advantages and disadvantages of each imaging modality and biomarker must be carefully weighed for appropriate application and reliable monitoring. The prevalence of small bowel lesions depends on the precision of the imaging modality used for detection. Clinical management should be based on the dominant location of the intestinal lesions rather than classical classification. Optimal strategies for detecting and treating small bowel lesions in patients with CD must be developed utilizing reliable, precise, and objective monitoring.

show abstract

Silent Crohnʼs Disease Predicts Increased Bowel Damage During Multiyear Follow-up

Cited by 30 publications

References 31 publications

Gastrointestinal hypoalgesia in inflammatory bowel disease

Gastrointestinal hypoalgesia in inflammatory bowel disease

A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation

Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

Contact Info

Product

Resources

About