Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity

Abstract

Crohn’s disease (CD) is principally characterized by chronic and recurrent inflammation of the gastrointestinal tract, most commonly found in the ileo-colonic region. The chronicity and severity of intestinal inflammation together contribute to progressive, cumulative, deep, transmural intestinal damage, including stricturing, obstruction, abscesses, and fistulae. Both intestinal inflammation and its chronic complications result in a range of symptoms subsequently leading to patient presentations with diarrhea, abdominal pain, and anemia related to intestinal blood loss. Measuring disease activity and severity are essential for decision of treatment intensity early in the disease course and longitudinal monitoring of therapeutic efficacy. This review will summarize the transition from subjective symptoms driving disease activity indices, into increasingly objective and quantitative measures of intestinal injury by direct mucosal assessment (endoscopy), cross-sectional imaging, and surrogate biomarkers. Specific commentary on intestinal stricture and perianal fistula assessment and management are presented in accompanying sections of this series.

Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review

“…Clinical studies evaluating efficacy of antifibrotic drug candidates in stricturing CD will face specific challenges. First, in contrast to luminal inflammation, in which severity of endoscopic lesions and severity of transmural changes assessed by cross-sectional imaging closely correlate,12 in stricturing lesions, routine endoscopic examination of the mucosa is insufficient for an accurate diagnosis. Biopsies are only superficial and not all strictures are accessible by endoscopy.…”

The Role of Multi-Detector Computed Tomography in Assessment of Chron’s Disease Progression: A Cross-sectional Study

“…Since its introduction in the late 1960s, the CDAI has become the most commonly utilized tool for the assessment of clinical activity in Chron's disease [15] . However, previous reports demonstrated that CDAI poorly predict the clinical behavior and treatment response in Chron's disease [16] .…”

Effects of Ustekinumab on Histologic Disease Activity in Patients With Crohn’s Disease

“…5 Clinical trials in CD have used disease indices such as the Crohn's Disease Activity Index (CDAI) 6 as primary endpoints, but both health authorities and investigators have recognized a need for more objective measures of treatment response. 7 One such measure is based on the appearance of the mucosa as visualized by video ileocolonoscopy, 8 and endoscopic mucosal healing has been associated with improved long-term outcome in CD. Considerably less is known about the clinical relevance of achieving histologic remission or the relationships among histologic, clinical, and/or endoscopic measures of CD.…”