P-044 YI Clinical Characteristics of Crohn’s Disease Patients With Complete Healing on Computed Tomography Enterography

Field: Medicine (Health Sciences)

Computed tomography enterography (CTE) is an important modality for the assessment of Crohn’s disease (CD) activity, and response to medical therapy. Intestinal wall remodeling detected on serial CTE in patients on medical therapy has been previously described. There is a paucity of data, however, regarding the clinical characteristics of the subset of patients with complete normalization / healing on CTE. A retrospective study was performed of patients with established CD who underwent serial CTE while being treated at our institution, between September 18, 2002 and December 31, 2008. Mural enhancement, comb sign (dilated vasa recta), stratification, and fatty proliferation were scored on a 5-point scale (0 = none, 1 = equivocal, 2 = mild, 3 = moderate, 4 = severe), while length of lesion was recorded in centimeters (cm). These data were recorded per lesion and per patient for initial and all follow-up CTEs. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders if all lesions improved on the second CTE, without worsening on subsequent CTEs. Among the responders, complete normalization was defined as a score of 0 or 1 for all recorded parameters and reduction in lesion length to 0. Patient characteristics including demographic data, disease duration, history of penetrating disease, and previous surgery for IBD were compared to the group without complete normalization. A total of 63 patients were identified, of whom 28 (57% female) were classified as responders. Among these, 6 patients (10 lesions) were identified with complete normalization of CTE-detected parameters of intestinal inflammation (Figures 1, 2 and 3). All 6 patients had 2 CTEs, with a median time between index and second CTE of 810.5 days (interquartile range [IQR] 735.8–871.8). Indication for 1st CTE was abdominal pain in 3 cases, disease assessment in 2 cases, and fever in 1 case. The 2nd CTE was performed for follow-up assessment of disease activity in 5 cases and abdominal pain in 1 case. All 6 cases were on combination therapy with a thiopurine (azathioprine or 6-mercaptopurine). No significant difference was seen in median age at 1st CTE compared to those without healing (n = 57) (28 years [IQR, 17.3–41.8] versus 40 years [IQR, 26.5–51], P = 0.16). A female predominance (n = 4) was seen, without significant gender difference between groups (odds ratio [OR], 0.42; CI, 0.07–2.48). Median disease duration was 3.5 years (IQR 2–28.5), comparable to non-healers (median 8 years [IQR, 3–20], P = 0.87). Among patients with radiologic healing, a history of perianal disease was present in 5 patients (83.3%) (OR 0.34; CI, 0.04–3.14), internal penetrating disease was present in 1 patient (16.7%) (OR 0.37; CI, 0.04–3.39), and a history of IBD surgery was present in 3 patients (50%) (OR 1.85; CI, 0.34–10.03). Complete normalization of CTE-detected lesions of inflammation occurs in a subset of patients with CD. Further investigation into predictive factors for complete normalization, as well natural history of disease after achievement of radiologic healing, is warranted.