Mesenteric pulsatility index analysis predicts response to azathioprine in patients with Crohn's disease.
OBJECTIVE
Mesenteric blood flow measurement has been found to predict relapse after steroid-induced remission in patients with Crohn's disease (CD) and ulcerative colitis (UC). Therefore, we assessed prospectively the possible relationship between changes in mesenteric blood flow and prognosis in chronically active patients with need of immunosuppressive therapy with azathioprine (AZA) or 6-mercaptopurine (6-MP).


METHODS
Doppler ultrasound (DUS) measurements of the pulsatility index (PI) of the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) were performed in 52 patients with chronically active inflammatory bowel disease (CD 31 patients; UC 21 patients) before beginning therapy with AZA/6-MP (US1) and during clinical remission (CD activity index <150, Truelove index score I) (US2). Patients were weaned from concomitant therapy with corticosteroids as soon as possible and were followed up for 12 months.


RESULTS
After 1 year, 16 patients with CD (51.6%) and 13 patients with UC (61.9%) were in remission, whereas 23 patients had recurrent disease or had undergone surgery. A decreased SMA PI at US2 predicted clinical relapse in all patients with CD [100%; P < 0.001; mean (+/-SD) 77 +/- 67 d after US1], but only 4 of 8 patients (50%; difference not significant; mean 84 +/- 75 d after US1) with UC. Conversely, an increase of SMA PI was associated with sustained remission in the majority of CD patients (12/16 patients; 75%; P < 0.002), but in only 7 of 13 patients (54%) with UC. Flow measurements in the IMA and postprandial values for both arteries were less reliable.


CONCLUSIONS
Repeated DUS measurements of the SMA PI predict response to AZA/6-MP in patients with chronic active CD.
Homann
Nils
N
Department of Internal Medicine I, Division of Gastroenterology, University of Schleswig-Holstein-Campus Lübeck, Lübeck, Germany.
Klarmann
Ute
U
Fellermann
Klaus
K
Brüning
Andreas
A
Klingenberg-Noftz
Rolf
R
Witthöft
Thomas
T
Stange
Eduard F
EF
Ludwig
Diether
D
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging* / Q000502:physiology; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging* / Q000502:physiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D007166:Immunosuppressive Agents; D001379:Azathioprine