Abdominal bowel ultrasound can predict the risk of surgery in Crohn's disease: proposal of an ultrasonographic score.
OBJECTIVE
Abdominal bowel ultrasound (US) is widely used in the management of Crohn's disease (CD). The aim of this study was to evaluate the prognostic role of bowel-wall US morphology on the short-term risk of surgery.


METHODS
The 147 CD patients recruited in a case-control study comprised 49 cases operated on within 30 days after US examination and 98 matched non-operated controls. Clinical and US characteristics were analysed. Bowel-wall thickness was recorded, bowel-wall patterns were grouped into five types, but for final analysis they were grouped as "preserved" or "disrupted stratification".


RESULTS
Wall thickness and US patterns were significantly different between cases and controls (p<0.0001). A wall thickness >4.5 mm was observed in 45/49 cases and 47/98 controls (OR = 12.21), while "disrupted stratification" was observed in 34/49 cases and 12/98 controls (OR = 16.24). Among the clinical and US characteristics recorded, only 4 US variables were independently associated with surgery (pattern, thickness, presence of fistulae/abscesses and stenoses) and considered for the US score=(2.5*US pattern)+(1.5*Bowel thickness)+(3*Presence of fistulae/abscesses)+(1.5*Presence of stenoses). Based on this score, up to 84% of patients were correctly classified according to actual status (operated/non-operated).


CONCLUSIONS
Although it needs further prospective validation, the score we propose seems to be a reliable prognostic marker for the short-term risk of surgery in CD. In particular, the score points out those patients with an impending risk of surgery who need careful and frequent control in order to decide on the right time for surgery.
Rigazio
Caterina
C
Gastroenterology Division, Inflammatory Bowel Disease Centre, AO Ordine Mauriziano, Turin, Italy. catrigazio@libero.it
Ercole
Elena
E
Laudi
Cristiana
C
Daperno
Marco
M
Lavagna
Alessandro
A
Crocella
Lucia
L
Bertolino
Franco
F
Viganò
Luca
L
Sostegni
Raffaello
R
Pera
Angelo
A
Rocca
Rodolfo
R
D000328:Adult; D000704:Analysis of Variance; D019540:Area Under Curve; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007422:Intestines / Q000000981:diagnostic imaging* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D012008:Recurrence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods*