Assessment of Bowel Inflammation and Strictures by Magnetic Resonance Enterography in Long-term Crohn's Disease

Abstract

Background: Crohns disease [CD] is a chronic inflammation in the gut that often progresses to fibrosis. Magnetic resonance enterography [MRE] is an important diagnostic tool in evaluating CD. We aimed to assess the prevalence of inflammation and stricturing disease in patients with long-term CD, and to investigate associations with clinical factors.

Methods: We performed a follow-up analysis of a population-based cohort of 237 CD patients in south-eastern Norway 20 years after diagnosis; 95 patients were examined with MRE, and the magnetic enterographic global score [MEGS] was calculated. We assessed inflammation and strictures during the follow-up. Association of the MEGS and bowel strictures with clinical variables was examined by univariate regression analysis.

Results: Of the 237 patients, 62 [65.3%] had active inflammation mostly affecting the terminal ileum; 35 [36.8%] had substantial inflammation according to MEGS, which associated with inflammatory biomarkers during the follow-up; and 25 [26.3%] had stricturing disease that associated with age (odds ratio [OR] = 0.92), initial use of systemic steroids [OR = 3.36], and inflammatory biomarkers. Most patients with strictures were treated with surgery without recurrence [n = 24, 42.1%] and seven [21.2%] strictures in the terminal ileum healed without surgery.

Conclusions: Twenty years after the diagnosis, the majority of patients had active inflammation, often complicated by stricturing disease. Most patients with strictures were treated with surgery without recurrence, and some strictures resolved over time. Inflammatory biomarkers, extensive and complicated disease type, and use of systemic medication associated with both inflammation and stricturing disease.

Keywords: Crohn’s disease; Magnetic resonance imaging [MRI]; epidemiology; inflammation; inflammatory bowel disease [IBD].