P4386 - Mild Hyperemia in the Absence of Bowel Wall Thickening on Intestinal Ultrasound is Associated With Clinical and Biochemical Disease Activity and Worse Disease Outcomes in Patients With Crohn’s Disease

Noa Krugliak Cleveland, MD¹, Evan N. Fear, BA¹, Emma A. Picker, BA¹, Jeremy A. Klein, MD², Alexandra McDermott, BS¹, Zachary D. Fine, BA¹, Yusuke Miyatani, MD, PhD¹, Joelle St-Pierre, MD, PhD¹, Benjamin D. McDonald, MD, PhD¹, David T.. Rubin, MD, FACG^1
1University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL; ²University of Chicago Medical Center, Chicago, IL

Introduction: Bowel wall thickness (BWT) measured by intestinal ultrasound (IUS) is the primary contributor to predicting endoscopic disease activity in Crohn’s disease (CD). Although hyperemia is associated with active disease, the clinical significance of mild hyperemia (mLim1) in the absence of BWT is not known. The aim of this study is to assess whether patients (pts) with CD, normal BWT and mild hyperemia have worse outcomes compared to pts with normal BWT and no hyperemia.

Methods: We reviewed index IUS exams of pts with CD at the University of Chicago from 7/18/2022 to 6/13/2023 and included pts with normal BWT (≤3.0mm) + mLim1 and compared them to pts with normal BWT + no hyperemia (mLim0). We excluded pts with mLim2 or 3, BWT >3mm anywhere on index IUS or those with mLim1 at surgical anastomoses only. Clinical (Harvey-Bradshaw Index (HBI)) and biochemical disease activity (fecal calprotectin (FCP) or C-reactive protein (CRP)) were assessed at the time of index IUS. Clinical remission was defined as HBI of < 5, FCP ≤150 μg/mg, CRP < 5 mg/L. The primary analysis was poor disease outcome within 1 year of follow-up, defined as: IBD medication change/escalation, prescription of corticosteroids, CD-related surgery, or CD-related hospitalization.

Results: We identified 33 pts (15 with mLim1, 18 with mLim0 (Table 1)). 8 (53.3%) pts with mLim1 and 7 (38.9%) with mLim0 had at least one marker of active disease at the time of index IUS. Of the 7 mLim1 pts in clinical remission at index IUS, 5 (71.4%) had a poor disease outcome within 1 year with median time to a poor disease outcome of 103 days (IQR 39.5-154). Of the 11 mLim0 pts in clinical remission at index IUS, 2 (18.2%) had a poor disease outcome within 1 year with median time to poor disease outcome of 179 days (IQR 134-193). (Table 1, Figure 1). 12 mLim1 pts had at least 1 follow-up IUS during the year; 6/12 (50%) had subsequent increased BWT and mLim1 or greater, with median time to abnormal IUS of 95 days (IQR 60.5-113.8). 12 mLim0 pts had at least 1 follow-up IUS during the 1 year; 1 (8.3%) had increased BWT and mLim1 or greater, with time to abnormal IUS of 154 days.

Discussion: Pts with CD, mild hyperemia and normal BWT have higher rates of concurrent biochemical and clinical disease activity, and higher rates of poor disease outcomes compared to pts with no hyperemia and normal BWT. We propose consideration of treatment adjustments when this isolated parameter is identified. Larger prospective studies are warranted to evaluate this further.



Disclosures:


Noa Krugliak Cleveland, MD¹, Evan N. Fear, BA¹, Emma A. Picker, BA¹, Jeremy A. Klein, MD², Alexandra McDermott, BS¹, Zachary D. Fine, BA¹, Yusuke Miyatani, MD, PhD¹, Joelle St-Pierre, MD, PhD¹, Benjamin D. McDonald, MD, PhD¹, David T.. Rubin, MD, FACG¹. P4386 - Mild Hyperemia in the Absence of Bowel Wall Thickening on Intestinal Ultrasound is Associated With Clinical and Biochemical Disease Activity and Worse Disease Outcomes in Patients With Crohn’s Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.