Plumb, AA;
Menys, A;
Russo, E;
Prezzi, D;
Bhatnagar, G;
Vega, R;
Halligan, S;
... Taylor, SA; + view all
(2015)
Magnetic resonance imaging-quantified small bowel motility is a sensitive marker of response to medical therapy in Crohn's disease.
Alimentary Pharmacology and Therapeutics
, 42
(3)
pp. 343-355.
10.1111/apt.13275.
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Abstract
Background: Magnetic resonance enterography (MRE) can measure small bowel motility, reduction in which reflects inflammatory burden in Crohn's Disease (CD). However, it is unknown if motility improves with successful treatment. / Aim: To determine if changes in segmental small bowel motility reflect response to anti-TNFα therapy after induction and longer term. / Methods: A total of 46 patients (median 29 years, 19 females) underwent MRE before anti-TNFα treatment; 35 identified retrospectively underwent repeat MRE after median 55 weeks of treatment and 11 recruited prospectively after median 12 weeks. Therapeutic response was defined by physician global assessment (retrospective group) or a ≥3 point drop in the Harvey–Bradshaw Index (prospective group), C-reactive protein (CRP) and the MaRIA score. Two independent radiologists measured motility using an MRE image-registration algorithm. We compared motility changes in responders and nonresponders using the Mann–Whitney test. / Results: Anti-TNFα responders had significantly greater improvements in motility (median = 73.4% increase from baseline) than nonresponders (median = 25% reduction, P < 0.001). Improved MRI-measured motility was 93.1% sensitive (95%CI: 78.0–98.1%) and 76.5% specific (95% CI: 52.7–90.4%) for anti-TNFα response. Patients with CRP normalisation (<5 mg/L) had significantly greater improvements in motility (median = 73.4% increase) than those with persistently elevated CRP (median = 5.1%, P = 0.035). Individuals with post-treatment MaRIA scores of <11 had greater motility improvements (median = 94.7% increase) than those with post-treatment MaRIA score >11 (median 15.2% increase, P = 0.017). / Conclusions: Improved MRI-measured small bowel motility accurately detects response to anti-TNFα therapy for Crohn's disease, even as early as 12 weeks. Motility MRI may permit early identification of nonresponse to anti-TNFα agents, allowing personalised treatment.
| Type: | Article |
|---|---|
| Title: | Magnetic resonance imaging-quantified small bowel motility is a sensitive marker of response to medical therapy in Crohn's disease |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/apt.13275 |
| Publisher version: | http://dx.doi.org/10.1111/apt.13275 |
| Language: | English |
| Additional information: | This is the peer reviewed version of the following article: Plumb, AA; Menys, A; Russo, E; Prezzi, D; Bhatnagar, G; Vega, R; Halligan, S; (2015) Magnetic resonance imaging-quantified small bowel motility is a sensitive marker of response to medical therapy in Crohn's disease. Alimentary Pharmacology and Therapeutics, 42 (3) pp. 343-355, which has been published in final form at: http://dx.doi.org/10.1111/apt.13275. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html#terms). |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Department of Imaging |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1469314 |
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