title: Radiological Response Is Associated With Better Long-Term Outcomes and Is a Potential Treatment Target in Patients With Small Bowel Crohn's Disease.
abstract: Crohn's disease (CD) management targets mucosal healing on ileocolonoscopy as a treatment goal. We hypothesized that radiologic response is also associated with better long-term outcomes.
  
  
  
  Small bowel CD patients between 1 January 2002 and 31 October 2014 were identified. All patients had pre-therapy computed tomography enterography (CTE)/magnetic resonance enterography (MRE) with follow-up CTE or MRE after 6 months, or 2 CTE/MREs≥6 months apart while on maintenance therapy. Radiologists characterized inflammation in up to five small bowel lesions per patient. At second CTE/MRE, complete responders had all improved lesions, non-responders had worsening or new lesions, and partial responders had other scenarios. CD-related outcomes of corticosteroid usage, hospitalization, and surgery were assessed using Kaplan-Meier survival analysis and multivariable Cox models.
  
  
  
  CD patients (n=150), with a median disease duration of 9 years, had 223 inflamed small bowel segments (76 with strictures and 62 with penetrating, non-perianal disease), 49% having ileal distribution. Fifty-five patients (37%) were complete radiologic responders, 39 partial (26%), and 56 non-responders (37%). In multivariable Cox models, complete and partial response decreased risk for steroid usage by over 50% (hazard ratio (HR)s: 0.37 (95% confidence interval (CI), 0.21-0.64); 0.45 (95% CI, 0.26-0.79)), and complete response decreased the risk of subsequent hospitalizations and surgery by over two-thirds (HRs: HR, 0.28 (95% CI, 0.15-0.50); HR, 0.34 (95% CI, 0.18-0.63)).
  
  
  
  Radiological response to medical therapy is associated with significant reductions in long-term risk of hospitalization, surgery, or corticosteroid usage among small bowel CD patients. These findings suggest the significance of radiological response as a treatment target.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Parakkal
authors.initials: P
authors.lastname: Deepak
authors.affiliation: Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.affiliation: Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.affiliation: Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Barlow
authors.affiliation: Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Shannon P
authors.initials: SP
authors.lastname: Sheedy
authors.affiliation: Division of Pediatric Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Kolbe
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Hansel
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Brenda D
authors.initials: BD
authors.lastname: Becker
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D012189:Retrospective Studies; D013995:Time; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data; D014481:United States
chemical_list: D005765:Gastrointestinal Agents; D005938:Glucocorticoids