P0548 Comparison of C-reactive protein level and intestinal ultrasonography in Crohn’s Disease activation
Authors: Yorulmaz E , Yigit B , Sezgin O , Erturk M S , Yanc U , Erdem U , Yorulmaz H , Bilik Oyman G 
Published: January 2025

Abstract

Background
Noninvasive diagnostic methods and laboratory parameters play an important role in the activation of Crohn’s Disease (CD). C-reactive protein (CRP) is one of the best laboratory measurements used to evaluate the activity of CD. Ultrasonography is a non-invasive, easily accessible, inexpensive, ionizing radiation-free imaging method that can be performed at the bedside. In this study, we aimed to compare CRP level and intestinal ultrasonography (IUS) findings in CD.

Methods
79 Crohn’s patients who applied due to activation or for routine control were included in the study. Patients with other causes of colitis, malignancy, chronic and rheumatological diseases that may cause elevated CRP were excluded from the study. CRP values of the patients were measured on the day of IUS. IUS examination was performed using the Toshiba aplio HDI-300 ultrasound system. The examination started from the right inguinal region using a convex probe (3.5-5.5 MHz). Wall thickness, wall echogenicity, mural stratification, involved segment, inflammation in mesenteric fat planes, lymphadenopathy, and intestinal complications such as stricture, abscess formation, and fistulas were examined using a linear probe (7-12 MHz). A wall thickness greater than 3 mm was considered pathologic. The short axis of mesenteric lymph nodes greater than 5 mm was considered pathologic. The Superior mesenteric artery (SMA) was examined by duplex color Doppler. In the spectral Doppler examination, the peak systolic velocity (PSV) and resistive index (RI) were assessed. The Limberg score was used to assess bowel wall vascularization. According to Limberg, intestinal wall vascularity is classified in 5 grades.

Results
In this study, increased intestinal wall thickness in IUS, inflammation findings in the mesenteric fatty planes and CRP values were highly significant (p&lt;0.001). CRP values were significantly higher in the group with decreased peristalsis and loss of wall layer delineation (p ˂ 0.01) and in complicated Crohn’s patients (p ˂ 0.05). CRP value did not differ significantly (p = 0.076) in the groups with and without lymphadenopathy detected on IUS. The CRP value in the group with a Limberg score of 1 and above was significantly higher (p &lt; 0.001) compared to the group with a Limberg score of 0. A significant (p &lt;0.05) positive correlation was observed between SMA flow velocity and CRP on Doppler USG. No correlation (p ˃0.05) was observed between RI, PSV and CRP on Doppler USG.

Conclusion
In this study, CRP elevation was found to be associated with many parameters of IUS in evaluating CD activity. In clinical use, CRP and IUS are simple, noninvasive, bedside diagnostic tools.

References
1)Haber HP, Busch A, Ziebach R, Stern M. Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children. The Lancet. 2000;355(9211):1239-40.
2)Kucharzik T, Wittig BM, Helwig U, Börner N, Rössler A, Rath S, et al. Use of intestinal ultrasound to monitor Crohn’s disease activity. Clinical Gastroenterology and Hepatology. 2017;15(4):535-42. e2.
3)Filik L, Dagli U, Ulker A. C-reactive protein and monitoring the activity of Crohn’s disease. Advances in therapy. 2006;23(4):655-62.