title: A sonographic lesion index for Crohn's disease helps monitor changes in transmural bowel damage during therapy.
abstract: OBJECTIVE
  Therapeutic antibodies against tumor necrosis factor α (anti-TNF) are effective in patients with Crohn's disease (CD). Mucosal healing is a surrogate marker of efficacy, but little is known about the effects of anti-TNF agents on structural damage in the intestine. Small-intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (the sonographic lesion index for CD [SLIC]) was developed to quantify changes in CD lesions detected by SICUS. We explored whether the SLIC can be used to monitor transmural bowel damage in CD patients during anti-TNF therapy.
  
  
  METHODS
  We performed a prospective study of 29 patients with ileal or ileocolonic CD treated with anti-TNF agents; patients underwent SICUS before and after scheduled induction and maintenance therapy. To determine whether changes that can be detected by SICUS occur independently of anti-TNF therapy, 7 patients with ileal CD treated with mesalamine were enrolled as controls. A clinical response was defined as steroid-free remission, with CD activity index scores less than 150.
  
  
  RESULTS
  We observed significant improvements in SLIC scores and subscores after induction and maintenance therapy with anti-TNFs, compared with before therapy. SLIC scores and subscores and index classes were improved significantly in patients with vs without clinical responses. Controls had no improvements in terms of CD activity index or SLIC scores, or index classes.
  
  
  CONCLUSIONS
  Sonographic assessment using the quantitative index SLIC can be used to monitor changes in transmural bowel damage during anti-TNF therapy for CD.
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Zorzi
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Stasi
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Gerolamo
authors.initials: G
authors.lastname: Bevivino
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Scarozza
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Biancone
authors.affiliation: Interdepartmental Center of Biostatistics and Bioinformatics, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Zuzzi
authors.affiliation: Interdepartmental Center of Biostatistics and Bioinformatics, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Rossi
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallone
authors.affiliation: Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy. Electronic address: emma.calabrese@uniroma2.it.
authors.forename: Emma
authors.initials: E
authors.lastname: Calabrese
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D007155:Immunologic Factors
keywords: Anti-TNFα; Crohn's Disease; Drug Monitoring; SICUS; Transmural Bowel Damage