Prediction of Crohn’s Disease Flare: Comparison of MRE, Video Capsule Endoscopy, and Biomarkers
2Department of Gastroenterology, Sheba Medical Center, Tel Hashomer & Sackler Medical School, Tel Aviv University, Israel
Background: Prediction of Crohn’s disease course is of utmost importance for treatment decisions. We compared three disease monitoring tools to predict flares in Crohn’s patients with quiescent disease.
Methods: This is an analysis of a prospective observational cohort study. Patients older than 18 years with quiescent Crohn`s disease involving the small bowel were enrolled. Aךך included patients underwent baseline magnetic resonance enterography (MRE), video capsule endoscopy (VCE) and biomarker assessment. Flares were defined as an increase in the Crohn`s disease activity index score by 70 points or more, or disease worsening necessitating treatment intensification.
The magnetic resonance enterography global score (MEGS) assessed the MRE disease activity and the Lewis indice assessed the VCE disease activity.
We assessed the ability of the different Crohn`s disease monitoring methods used to predict the occurrence of a flare during the 24-month follow-up period.
Results: 61 patients were enrolled in the study. Of them, 17 (28%) had a flare during the 24-month follow-up.
The baseline MEGS score correlated with 2-year flare risk (AUC 0·71, 0·58-0·82; p=0·024). A baseline VCE Lewis score of 350 or more identified patients with future flare (AUC 0.79, 95% CI 0.66-0.88; p<0·0001). C-reactive protein at baseline had an AUC of 0.73 (0.60-0.84; p=0.0013) for predicting flare. The AUC of baseline fecal calprotectin for the prediction of flare occurring within 2 years was 0.62 (0.49-0.74; p=0.17).
Conclusion: In patients with quiescent Crohn`s disease involving the small bowel, baseline VCE showed the highest ability to predict disease flare in two years. These data may be useful for devising monitoring strategies for quiescent Crohn’s disease.