Endoscopic Complete Remission of Crohn Disease After Anti-Tumor Necrosis Factor-α Therapy: CT Enterographic Findings and Their Clinical Implications.

Abstract

OBJECTIVE:

The purpose of this study was to describe the CT enterographic (CTE) findings after endoscopic complete remission (CR) of Crohn disease in patients treated with anti-tumor necrosis factor-α (anti-TNF-α) and the clinical implications of these findings.

MATERIALS AND METHODS:

The records of 27 patients with Crohn disease (14 men, 13 women; mean age, 28.4 ± 8.6 [SD] years) who achieved endoscopic (ileocolonoscopic) CR after anti-TNF-α therapy and underwent CTE both before therapy and at endoscopic CR were identified. Two readers independently assessed the frequencies and severities of mural and perienteric CTE abnormalities, generally regarded as active inflammatory findings, in the terminal ileum and colorectum in the endoscopic CR state and compared them with the corresponding findings before anti-TNF-α therapy. The association between the presence of CTE abnormalities in the face of endoscopic CR and patient outcome during subsequent follow-up was investigated.

RESULTS:

CTE abnormalities were present in the face of endoscopic CR in 11-18 (26-42%) of 43 bowel sections (18 terminal ileum, 25 colorectum), the most frequent being mural hyperenhancement (21-40%) followed by mural thickening (12-16%). Both findings were mild and unaccompanied by other findings. The frequency and severity of mural and perienteric CTE abnormalities were statistically significantly reduced at endoscopic CR compared with the pre-treatment state. Patients with (n = 10) and without (n = 17) CTE abnormalities at endoscopic CR did not significantly differ with respect to Crohn disease aggravation during subsequent follow-up periods averaging 27.4 and 28.5 months (0/10 versus 2/17, p = 0.516).

CONCLUSION:

More than one-fourth of bowel sections in endoscopic CR after anti-TNF-α therapy had residual CTE abnormalities, predominantly mild mural thickening or hyperenhancement. These findings may not have any clinical significance.

• Authors: Cherry Kim, Seong Ho Park, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park, Jong Seok Lee, Hyun Jin Kim, Ah Young Kim, Hyun Kwon Ha
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 206 Issue 6 Pg. 1208-16 (Jun 2016) ISSN: 1546-3141 [Electronic] United States
• PMID: 26998628 (Publication Type: Journal Article, Observational Study)

Chemical References

• Tumor Necrosis Factor-alpha

Topics

• Adult
• Crohn Disease (diagnostic imaging, drug therapy)
• Endoscopy
• Female
• Humans
• Male
• Remission Induction
• Reproducibility of Results
• Retrospective Studies
• Tomography, X-Ray Computed
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors, therapeutic use)
• Young Adult