Imaging of the small intestine in Crohn’s disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association

Kedia, Saurabh; Sharma, Raju; Makharia, Govind; Ahuja, Vineet; Desai, Devendra; Kandasamy, Devasenathipathy; Eapen, Anu; Ganesan, Karthik; Ghoshal, Uday C; Kalra, Naveen; Karthikeyan, D; Madhusudhan, Kumble Seetharama; Mathew, Philip; Puri, Amarender Singh; Puri, Sunil K.; Sinha, Saroj Kant; Banerjee, Rupa; Bhatia, Shobna; Bhat, Naresh; Dadhich, Sunil; Dhali, Gopal Krishna; Goswami, Bhabhadev; Issar, Sanjeev Kumar; Venkataraman, Jayanthi; Misra, Sri Prakash; Nijhawan, Sandeep; Puri, Pankaj; Sarkar, Avik; Singh, Shivram Prasad; Srivastava, Anshu; Abraham, Philip; Ramakrishna, B. S.

doi:10.1007/s12664-017-0804-y

Cited by 14 publications

(7 citation statements)

References 148 publications

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“…Computed tomographic (CT)/magnetic resonance (MR) enterography are the preferred imaging modalities for evaluating and differentiating between patients with CD and ITB[48,49]. As compared to endoscopy, cross-sectional imaging has the advantage of non-invasively imaging the entire intestinal tract and it complements other investigations in differentiation between CD and ITB[50].…”

Section: Radiologymentioning

confidence: 99%

Differentiating Crohn’s disease from intestinal tuberculosis

Kedia

Das

Madhusudhan

et al. 2019

WJG

Self Cite

143

109

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Differentiating Crohn’s disease (CD) and intestinal tuberculosis (ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical (diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic (longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic (caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic (positive stain/culture for acid fast-bacillus in ITB), radiologic (long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus (AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However, these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy (ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.

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Section: Radiologymentioning

confidence: 99%

Differentiating Crohn’s disease from intestinal tuberculosis

Kedia

Das

Madhusudhan

et al. 2019

WJG

Self Cite

143

109

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“…Finally, it should be noted that advances in CT imaging protocols and post-imaging processing techniques have reduced the effective dose of radiation per imaging study ( 36–38 ). Nevertheless, alternate safer imaging modalities exist such as abdominal ultrasound, which has been shown to be effective in detecting IBD complications ( 20–22 , 26 , 39–41 ). Although point of care ultrasound is used commonly in the ED for many clinical indications, it is not yet routinely used for IBD ( 42 , 43 ).…”

Section: Discussionmentioning

confidence: 99%

“…The 2016 Canadian Choosing Wisely campaign advised CT imaging in the acute setting only when there is high suspicion of complications (abscess, perforation or obstruction), or when symptoms suggest a non-IBD etiology ( 19 ). Moreover, the European Crohn’s and Colitis Organization (ECCO), the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), and the British Society of Gastroenterology advise consideration of MR enterography and ultrasound as alternatives ( 20 , 21 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

Persistently High Rates of Abdominal Computed Tomography Imaging Among Patients With Inflammatory Bowel Disease Who Present to the Emergency Department

Kandel

Merlano

Tan

et al. 2022

Journal of the Canadian Association of Gastroenterology

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Background Recent guidelines recommended judicious use of abdominal computed tomography (CT) in the emergency department (ED) for inflammatory bowel disease. Trends in CT utilization over the last decade, including since the implementation of these guidelines, remain unknown. Methods We performed a single-centre, retrospective study between 2009 and 2018 to assess trends in CT utilization within 72 h of an ED encounter. Changes in the annual rates of CT imaging among adults with IBD were estimated by Poisson regression and CT findings by Cochran-Armitage or Cochran-Mantel Haenszel tests. Results A total of 3000 abdominal CT studies were performed among 14,783 ED encounters. CT utilization increased annually by 2.7% in Crohn’s disease (CD) (95% confidence interval [CI], 1.2 to 4.3; P = 0.0004), 4.2% in ulcerative colitis (UC) (95% CI, 1.7 to 6.7; P = 0.0009) and 6.3% in IBD unclassifiable (95% CI, 2.5 to 10.0; P = 0.0011). Among encounters with gastrointestinal symptoms, 60% with CD and 33% with UC underwent CT imaging in the final year of the study. Urgent CT findings (obstruction, phlegmon, abscess or perforation) and urgent penetrating findings alone (phlegmon, abscess or perforation) comprised 34% and 11% of CD findings, and 25% and 6% of UC findings, respectively. The CT findings remained stable overtime for both CD (P = 0.13) and UC (P = 0.17). Conclusion Our study demonstrated persistently high rates of CT utilization among patients with IBD who presented to the ED over the last decade. Approximately one third of scans demonstrated urgent findings, with a minority demonstrating urgent penetrating findings. Future studies should aim to identify patients in whom CT imaging is most appropriate.

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“…In Asian and North American guidelines, IUS was not prioritized when compared to MRE or CTE [ 22 , 23 ]. Indian guidelines particularly emphasizes the use of contrast-enhanced ultrasonography for the differentiation of inflammatory and fibrotic strictures [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of intestinal ultrasound with a portable system in the management of Crohn’s disease

Gönen

Sürmelioğlu

Koçhan

et al. 2020

Gastroenterology Report

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Background Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn’s disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients. Methods A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients’ clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD). Results The initial clinical-management decision was changed in 47 patients (40.2%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2% to 90.6% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD ≥3) assessment was shown to be comparable to that of IUS (94% vs 91%). The sensitivity for disease presence was 95% with colonoscopy and 94% with the IUS assessment. Conclusion IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.

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Imaging of the small intestine in Crohn’s disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association

Cited by 14 publications

References 148 publications

Differentiating Crohn’s disease from intestinal tuberculosis

Differentiating Crohn’s disease from intestinal tuberculosis

Persistently High Rates of Abdominal Computed Tomography Imaging Among Patients With Inflammatory Bowel Disease Who Present to the Emergency Department

Impact of intestinal ultrasound with a portable system in the management of Crohn’s disease

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