Mesenteric blood flow is related to disease activity and risk of relapse in Crohn's disease: a prospective follow-up study.
OBJECTIVE
The diagnostic significance of increased splanchnic blood flow in Crohn's disease is unclear. This prospective study was therefore undertaken to define the role of Doppler sonography in the assessment of disease activity and in the prediction of early relapse.


METHODS
Splanchnic flowmetry was performed in 59 patients with Crohn's disease and 20 healthy volunteers during fasting and 30 min after ingestion of a standardized meal. Twenty-one patients measured during the active state and in clinical remission were followed-up for 6 months. Hemodynamic parameters of the superior and inferior mesenteric arteries and the portal vein were related to clinical (Crohn's disease activity index [CDAI]), laboratory (C-reactive protein), and endoscopic (Crohn's Disease Endoscopic Index of Severity) parameters of disease activity.


RESULTS
The postprandial mean velocity of the superior mesenteric artery correlated closest with clinical activity (CDAI, p < 0.005) and C-reactive protein (p < 0.01), but was unrelated to endoscopic activity. All patients in remission after 6 months (9/9) showed an increase in postprandial pulsatility index of the superior mesenteric artery, compared with an initial measurement during active disease (+28%). In contrast, the majority of patients with later relapse or surgery (11/12) had decreased pulsatility index during initial remission (-20%). The positive predictive value of this index for maintenance of remission was 0.82.


CONCLUSIONS
Postprandial flow measurements in the superior mesenteric artery are closely related to clinical but not endoscopic disease activity in patients with Crohn's disease. The repeated measurement of the postprandial pulsatility index allows estimation of the risk of recurrence.
Ludwig
D
D
Department of Internal Medicine I, University of Lübeck, Germany.
Wiener
S
S
Brüning
A
A
Schwarting
K
K
Jantschek
G
G
Stange
E F
EF
D000328:Adult; D001783:Blood Flow Velocity; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000503:physiopathology; D019518:Postprandial Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011673:Pulsatile Flow; D012008:Recurrence; D012307:Risk Factors; D013152:Splanchnic Circulation; D018608:Ultrasonography, Doppler