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Crohn Disease: HELP
Articles by David H. Bruining
Based on 45 articles published since 2010
(Why 45 articles?)
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Between 2010 and 2020, D. Bruining wrote the following 45 articles about Crohn Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. 2018

Bruining, David H / Zimmermann, Ellen M / Loftus, Edward V / Sandborn, William J / Sauer, Cary G / Strong, Scott A / Anonymous1330933. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. · Department of Gastroenterology, University of Florida, Gainesville, Florida. · Division of Gastroenterology, University of California San Diego, San Diego, California. · Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia. · Division of GI Surgery, Northwestern Medicine, Chicago, Illinois. ·Gastroenterology · Pubmed #29329905.

ABSTRACT: Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented.

2 Review Interdisciplinary Updates in Crohn's Disease Reporting Nomenclature, and Cross-Sectional Disease Monitoring. 2018

Baker, Mark E / Fletcher, Joel G / Al-Hawary, Mahmoud / Bruining, David. ·Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue - L10, Cleveland, OH 44195, USA. Electronic address: bakerm@ccf.org. · Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. · Department of Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 489109, USA. · Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. ·Radiol Clin North Am · Pubmed #30119768.

ABSTRACT: Computed tomography enterography and magnetic resonance enterography are essential in the evaluation and treatment of patients with Crohn's disease. As such, examination reporting must use standardized nomenclature for effective communication. This report documents an interdisciplinary consensus of the Society of Abdominal Radiology, the Society of Pediatric Radiology, and the American Gastroenterology Association on the computed tomography enterography/magnetic resonance enterography imaging findings and imaging-based morphologic phenotypes.

3 Review Diffusion-weighted MRI in inflammatory bowel disease. 2018

Pouillon, Lieven / Laurent, Valérie / Pouillon, Marc / Bossuyt, Peter / Bonifacio, Christiana / Danese, Silvio / Deepak, Parakkal / Loftus, Edward V / Bruining, David H / Peyrin-Biroulet, Laurent. ·Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France; Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. · Department of Radiology, Nancy University Hospital, Université de Lorraine, Nancy, France. · Department of Radiology, GZA Ziekenhuizen, Antwerp, Belgium. · Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. · Department of Radiology, Humanitas Research Hospital, Milan, Italy. · Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy. · Division of Gastroenterology, Washington University in St Louis School of Medicine, St Louis, MO, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA. · Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France. Electronic address: peyrinbiroulet@gmail.com. ·Lancet Gastroenterol Hepatol · Pubmed #29739674.

ABSTRACT: Cross-sectional MRI is an attractive alternative to endoscopy for the objective assessment of patients with inflammatory bowel disease (IBD). Diffusion-weighted imaging is a specialised technique that maps the diffusion of water molecules in biological tissues and can be done without intravenous gadolinium contrast injection. Diffusion-weighted imaging further expands the capability of traditional MRI sequences in IBD. However, the use of quantitative parameters, such as the apparent diffusion coefficient, is limited by low reproducibility. The Nancy score is a luminal disease activity index applied in diffusion-weighted imaging, and comprises only qualitative parameters. The score is accurate in Crohn's disease and ulcerative colitis, and requires no fasting or bowel preparation for assessment of colonic disease. However, deficiency of anatomic detail limits the use of diffusion-weighted imaging for assessment of intra-abdominal Crohn's disease complications. The contribution of such imaging in the prediction of disease course and treatment response in patients with IBD remains to be determined.

4 Review Endoscopic and Radiographic Assessment of Crohn's Disease. 2017

Al-Bawardy, Badr / Hansel, Stephanie L / Fidler, Jeff L / Barlow, John M / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: albawardy.badr@mayo.edu. · Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. · Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. ·Gastroenterol Clin North Am · Pubmed #28838411.

ABSTRACT: Crohn's disease is a chronic inflammatory disorder that can progress to obstructive and penetrating complications. Although clinical symptoms are an important component of therapy, they correlate poorly with objective measures of inflammation. The treatment targets have evolved from clinical improvement only to the addition of more objective measures, such as endoscopic mucosal healing and radiologic response, which have been associated with favorable long-term outcomes, including reduced hospitalizations, surgeries, and need for corticosteroids. There are multiple endoscopic and radiologic scoring systems that can aid in quantifying disease activity and response to therapy. These modalities and scoring tools are discussed in this article.

5 Review MR Imaging of Perianal Crohn Disease. 2017

Sheedy, Shannon P / Bruining, David H / Dozois, Eric J / Faubion, William A / Fletcher, Joel G. ·From the Departments of Radiology (S.P.S., J.G.F.), Internal Medicine (D.H.B., W.A.F.), and Surgery (E.J.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905. ·Radiology · Pubmed #28218881.

ABSTRACT: Pelvic magnetic resonance (MR) imaging is currently the standard for imaging perianal Crohn disease. Perianal fistulas are a leading cause of patient morbidity because closure often requires multimodality treatments over a prolonged period of time. This review summarizes clinically relevant anal sphincter anatomy, imaging methods, classification systems, and treatment objectives. In addition, the MR appearance of healing perianal fistulas and fistula complications is described. Difficult imaging tasks including the assessment of rectovaginal fistulas and ileoanal anastomoses are highlighted, along with illustrative cases. Emerging innovative treatments for perianal Crohn disease are now available and have the promise to better control sepsis and maintain fecal continence. Different treatment modalities are selected based on fistula anatomy, patient factors, and management goals (closure versus sepsis control). Radiologists can help maximize patient care by being familiar with MR imaging features of perianal Crohn disease and knowledgeable about what features may influence therapy decisions.

6 Review Crohn's disease diagnosis, treatment approach, and management paradigm: what the radiologist needs to know. 2017

Deepak, Parakkal / Park, Sang Hyoung / Ehman, Eric C / Hansel, Stephanie L / Fidler, Jeff L / Bruining, David H / Fletcher, Joel G. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Department of Gastroenterology, Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. · Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA. · Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA. fletcher.joel@mayo.edu. ·Abdom Radiol (NY) · Pubmed #28210767.

ABSTRACT: Crohn's disease is one of the major subtypes of idiopathic inflammatory bowel disease and is characterized by chronic transmural intestinal inflammation of the gastrointestinal tract anywhere from mouth to the anus, with a predilection for the small bowel. Cross-sectional imaging with computed tomography and magnetic resonance enterography plays a key role in confirming diagnosis, identifying and managing complications, assessing disease severity, and identifying response to medical therapy. This review will focus on the role of radiologists in the diagnosis and assessment of Crohn's disease. Additionally, a review of current medical therapy approaches, available medications, and side effects will be discussed. The review will also highlight key complications of medical therapy and associated diseases that should be evaluated by the radiologist with cross-sectional imaging.

7 Review Computed Tomography and Magnetic Resonance Enterography in Crohn's Disease: Assessment of Radiologic Criteria and Endpoints for Clinical Practice and Trials. 2016

Deepak, Parakkal / Fletcher, Joel G / Fidler, Jeff L / Bruining, David H. ·*Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota; †Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota; and ‡Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #27508513.

ABSTRACT: Early recognition of Crohn's disease with initiation of disease-modifying therapy has emerged as a prominent inflammatory bowel disease management strategy. Clinical practice and trials have often focused on patient symptoms, and more recently, serologic tests, stool inflammatory markers, and/or endoscopic inflammatory features for study entry criteria, treatment targets, disease activity monitoring, and to assess therapeutic response. Unfortunately, patient symptoms do not correlate well with biological disease activity, and endoscopy potentially misses or underestimates disease extent and severity in small bowel Crohn's disease. Computed tomography enterography and magnetic resonance enterography (MRE) are potential tools to identify and quantify transmural structural damage and disease activity in the small bowel. In this review, we discuss the role of computed tomography enterography and MRE in disease management algorithms in clinical practice. We also compare the currently developed MRE-based scoring systems, their strengths and pitfalls, as well as the role for MRE in clinical trials for Crohn's disease.

8 Review Bowel Ultrasonography in the Management of Crohn's Disease. A Review with Recommendations of an International Panel of Experts. 2016

Calabrese, Emma / Maaser, Christian / Zorzi, Francesca / Kannengiesser, Klaus / Hanauer, Stephen B / Bruining, David H / Iacucci, Marietta / Maconi, Giovanni / Novak, Kerri L / Panaccione, Remo / Strobel, Deike / Wilson, Stephanie R / Watanabe, Mamoru / Pallone, Francesco / Ghosh, Subrata. ·*Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; †Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany; ‡Klinik für Allgemeine Innere Medizin und Gastroenterologie, Lüneburg, Germany; §Digestive Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ‖Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota; ¶Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada; **Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy; ††University Hospital Erlangen, Erlangen, Germany; and ‡‡Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University Hospital, Tokyo, Japan. ·Inflamm Bowel Dis · Pubmed #26958988.

ABSTRACT: BACKGROUND: Bowel ultrasonography (US) is considered a useful technique for assessing mural inflammation and complications in Crohn's disease (CD). The aim of this review is to appraise the evidence on the accuracy of bowel US for CD. In addition, we aim to provide recommendations for its optimal use. METHODS: Publications were identified by literature search from 1992 to 2014 and selected based on predefined criteria: 15 or more patients; bowel US for diagnosing CD, complications, postoperative recurrence, activity; adequate reference standards; prospective study design; data reported to allow calculation of sensitivity, specificity, agreement, or correlation values; articles published in English. RESULTS: The search yielded 655 articles, of which 63 were found to be eligible and retrieved as full-text articles for analysis. Bowel US showed 79.7% sensitivity and 96.7% specificity for the diagnosis of suspected CD, and 89% sensitivity and 94.3% specificity for initial assessment in established patients with CD. Bowel US identified ileal CD with 92.7% sensitivity, 88.2% specificity, and colon CD with 81.8% sensitivity, 95.3% specificity, with lower accuracy for detecting proximal lesions. The oral contrast agent improves the sensitivity and specificity in determining CD lesions and in assessing sites and extent. CONCLUSIONS: Bowel US is a tool for evaluation of CD lesions in terms of complications, postoperative recurrence, and monitoring response to medical therapy; it reliably detects postoperative recurrence and complications, as well as offers the possibility of monitoring disease progression.

9 Review Update on the Medical Management of Crohn's Disease. 2015

Deepak, Parakkal / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. deepak.parakkal@mayo.edu. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. bruining.david@mayo.edu. ·Curr Gastroenterol Rep · Pubmed #26363802.

ABSTRACT: The medical management of Crohn's disease is a rapidly evolving field with expanding therapeutic drug options and treatment strategies. In addition to corticosteroids, immunomodulators, and anti-tumor necrosis (anti-TNF) agents, a new anti-adhesion medication (vedolizumab) has been approved. Individualized patient-based dosing of immunomodulators and biologic agents is now possible with therapeutic drug monitoring (TDM). There is a changing paradigm in treatment goals to achieve deeper remission identified by composite clinical and endoscopic endpoints. More aggressive treatment strategies in the postoperative setting have been proposed due to emerging data on medication efficacy in this setting. Management algorithms that stratify CD patients into risk groups to balance treatment benefit against adverse events and costs are being developed to translate research into clinical practice. This review provides an update on these new developments for practicing gastroenterologists.

10 Review CT and MR enterography in Crohn's disease: current and future applications. 2015

Bruining, David H / Bhatnagar, Gauraang / Rimola, Jordi / Taylor, Stuart / Zimmermann, Ellen M / Fletcher, Joel G. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA, bruining.david@mayo.edu. ·Abdom Imaging · Pubmed #25637127.

ABSTRACT: -- No abstract --

11 Review Do not assume symptoms indicate failure of anti-tumor necrosis factor therapy in Crohn's disease. 2011

Bruining, David H / Sandborn, William J. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. ·Clin Gastroenterol Hepatol · Pubmed #21277392.

ABSTRACT: It is a challenge to monitor patients with Crohn's disease who remain symptomatic despite anti-tumor necrosis factor therapy. Clinicians must use a systematic approach for each patient and obtain objective evidence about disease activity and response to therapy. Alternate etiologies for symptoms should be sought and treated, if found. Active Crohn's disease despite therapy requires reassessment and adjustments to management plans.

12 Clinical Trial Tacrolimus salvage in anti-tumor necrosis factor antibody treatment-refractory Crohn's disease. 2013

Gerich, Mark E / Pardi, Darrell S / Bruining, David H / Kammer, Patricia P / Becker, Brenda D / Tremaine, William T. ·Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, Colorado 80045, USA. mark.gerich@ucdenver.edu ·Inflamm Bowel Dis · Pubmed #23518805.

ABSTRACT: BACKGROUND: Several small retrospective studies have reported encouraging response rates in patients with Crohn's disease (CD) treated with tacrolimus. METHODS: We conducted a retrospective study of the use of oral tacrolimus for severe CD refractory to anti-tumor necrosis factor agents. Response was defined as a clinician's assessment of improvement after at least 7 days of treatment of one or more of the following: bowel movement frequency, fistula output, rectal bleeding, abdominal pain, extraintestinal manifestations, or well-being. Remission required all of the following: <3 stools per day, no bleeding, abdominal pain or extraintestinal manifestations, and increased well-being. RESULTS: Twenty-four eligible patients were treated with tacrolimus for a median of 4 months. Approximately 37% were steroid dependent or steroid refractory. Response and steroid-free remission rates were 67% and 21%, respectively, and lasted for a median of 4 months. Approximately 42% of patients were able to stop steroids and 54% of patients ultimately required surgery within a median of 10 months after starting tacrolimus. Patients with mean tacrolimus trough levels of 10 to 15 ng/mL had the highest rates of response (86%) and remission (57%). Surgery seemed to be postponed in this group compared with others. An adverse event occurred in 75% of patients. Eight of these events (33%) required dose reduction and 6 (25%) led to treatment discontinuation. There were no irreversible side effects or deaths attributable to tacrolimus over a median follow-up of 56 months. CONCLUSIONS: Oral tacrolimus seems to be safe and effective in some patients with severe CD refractory to anti-tumor necrosis factor therapy, particularly at a mean trough level of 10 to 15 ng/mL.

13 Clinical Trial Natalizumab for moderate to severe Crohn's disease in clinical practice: the Mayo Clinic Rochester experience. 2012

Kane, S V / Horst, S / Sandborn, W J / Becker, B / Neis, B / Moscandrew, M / Hanson, K A / Tremaine, W J / Bruining, D H / Faubion, W A / Pardi, D S / Harmsen, W S / Zinsmeister, A R / Loftus, E V. ·Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. kane.sunanda@mayo.edu ·Inflamm Bowel Dis · Pubmed #22419661.

ABSTRACT: BACKGROUND: Not all patients with Crohn's disease (CD) respond or maintain response to anti-tumor necrosis factor (TNF) agents and alternative treatment is necessary. Natalizumab, a monoclonal antibody to alpha-4 integrin approved for CD, has demonstrated efficacy in randomized clinical trials. We describe our experience with natalizumab in clinical practice at Mayo Clinic Rochester. METHODS: Consecutive patients prescribed natalizumab for active CD were invited to participate and were followed prospectively. Incidence of infection, hospitalization, neoplasm, or other adverse events were recorded. Clinical activity was assessed using the Harvey-Bradshaw Index at each 30-day infusion visit. RESULTS: Between April 2008 and September 2010, 36 patients were prescribed natalizumab and 30 (83.3%) agreed to participate. Median disease duration was 9 years (range, 3-43). Twenty-three patients had prior exposure to two anti-TNF agents, seven to one agent. All patients experienced at least one adverse event; none of the 13 patients in whom natalizumab was stopped (43%) discontinued due to adverse events. Five patients had infusions held for infection. No patient developed progressive multifocal leukoencephalopathy (PML). Fourteen patients (46%) had clinical response. The cumulative probability of achieving complete response within 1 year was 56% (28%-73%). Four of seven patients were weaned off corticosteroids. CONCLUSIONS: In our experience with natalizumab in clinical practice, adverse events were manageable and did not result in treatment cessation. No PML cases were seen and clinical response was similar to that in clinical trials. Natalizumab results in clinical benefit in patients who have active disease and have failed anti-TNF therapy.

14 Article Quantitative Inflammation Assessment for Crohn Disease Using Ultrasensitive Ultrasound Microvessel Imaging: A Pilot Study. 2020

Gong, Ping / Song, Pengfei / Kolbe, Amy B / Sheedy, Shannon P / Huang, Chengwu / Ling, Wenwu / Yu, Yue / Zhou, Chenyun / Lok, U Wai / Tang, Shanshan / Bruining, David H / Knudsen, John M / Chen, Shigao. ·Departments of Radiology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China. · Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. ·J Ultrasound Med · Pubmed #32297357.

ABSTRACT: OBJECTIVES: Crohn disease (CD) is a chronic inflammation in the digestive tract that affects millions of Americans. Bowel vascularity has important diagnostic information because inflammation is associated with blood flow changes. We recently developed an ultrasensitive ultrasound microvessel imaging (UMI) technique with high vessel sensitivity. This study aimed to evaluate the feasibility of UMI to assist CD detection and staging. METHODS: Ultrasound microvessel imaging was performed on 76 bowel wall segments from 48 symptomatic patients with CD. Clinically indicated computed tomographic/magnetic resonance enterography was used as the reference standard. The vessel-length ratio (VLR, the number of vessel pixels in the bowel wall segment normalized to the segment length) was derived in both conventional color flow imaging (CFI) and UMI to quantitatively stage disease activity. Receiver operating characteristic curves were then analyzed between different disease groups. RESULTS: The VLR-CFI and VLR-UMI detected similar correlations between vascularization and disease activity: severe inflammation had a higher VLR than normal/mildly inflamed bowels (P < .05). No significant difference was found between quiescent and mild CD due to the small sample size. The VLR-CFI had more difficulties in distinguishing quiescent versus mild CD compared to the VLR-UMI. After combining the VLR-UMI with thickness, in the receiver operating characteristic curve analysis, the areas under the curves (AUCs) improved to AUC CONCLUSIONS: Ultrasound microvessel imaging offers a safe and cost-effective tool for CD diagnosis and staging, which may potentially assist disease activity classification and therapy efficacy evaluation.

15 Article Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn's Disease Disease-Focused Panel. 2020

Gandhi, Namita S / Dillman, Jonathan R / Grand, David J / Huang, Chenchan / Fletcher, Joel G / Al-Hawary, Mahmoud M / Anupindi, Sudha A / Baker, Mark E / Bruining, David H / Chatterji, Manjil / Fidler, Jeff L / Gee, Michael S / Grajo, Joseph R / Guglielmo, Flavius F / Jaffe, Tracy A / Park, Seong Ho / Rimola, Jordi / Taouli, Bachir / Taylor, Stuart A / Yeh, Benjamin. ·Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA. gandhin@ccf.org. · Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. · Department of Radiology, Rhode Island Hospital, Providence, RI, USA. · Department of Radiology, New York University Langone Health, New York, NY, USA. · Department of Radiology, Mayo Clinic, Rochester, MN, USA. · Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA. · Department of Radiology, Children's Hospital of Philadelphia & University of Pennsylvania, Philadelphia, PA, USA. · Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. · Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA. · Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA. · Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. · Department of Radiology, Duke University Medical Center, Durham, NC, USA. · Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. · Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain. · Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Centre for Medical Imaging, University College London, London, UK. · Department of Radiology, University of California, San Francisco, USA. ·Abdom Radiol (NY) · Pubmed #31982931.

ABSTRACT: PURPOSE: To survey Society of Abdominal Radiology Crohn's Disease (CD) Disease-Focused Panel (DFP) members to understand state-of-the-art CT/MR enterography (CTE/MRE) protocols and variability between institutions. METHODS: This study was determined by an institutional review board to be "exempt" research. The survey consisted of 70 questions about CTE/MRE patient preparation, administration of contrast materials, imaging techniques, and other protocol details. The survey was administered to DFP members using SurveyMonkey® (Surveymonkey.com). Descriptive statistical analyses were performed. RESULTS: Responses were received from 16 DFP institutions (3 non-USA, 2 pediatric); 15 (94%) were academic/university-based. 10 (63%) Institutions image most CD patients with MRE; 4 (25%) use CTE and MRE equally. Hypoperistaltic medication is given for MRE at 13 (81%) institutions versus only 2 (13%) institutions for CTE. Most institutions have a technologist or nurse monitor oral contrast material drinking (n = 12 for CTE, 75%; n = 11 for MRE, 69%). 2 (13%) institutions use only dual-energy capable scanners for CTE, while 9 (56%) use either a single-energy or dual-energy scanner based on availability. Axial CTE images are reconstructed at 2-3 mm thickness at 8 (50%) institutions, > 3 mm at 5 (31%), and < 2 mm at 3 (19%) institutions. 13 (81%) institutions perform MRE on either 1.5 or 3T scanners without preference. All institutions perform MRE multiphase postcontrast imaging (median = 4 phases), ranging from 20 to 600 s after contrast material injection. CONCLUSION: CTE and MRE protocol knowledge from DFP institutions can help radiology practices optimize/standardize protocols, potentially improving image quality and patient outcomes, permitting objective comparisons between examinations, and facilitating research.

16 Article Imaging Findings of Ileal Inflammation at Computed Tomography and Magnetic Resonance Enterography: What do They Mean When Ileoscopy and Biopsy are Negative? 2020

Nehra, Avinash K / Sheedy, Shannon P / Wells, Michael L / VanBuren, Wendaline M / Hansel, Stephanie L / Deepak, Parakkal / Lee, Yong S / Bruining, David H / Fletcher, Joel G. ·Division of Abdominal Imaging, Mayo Clinic, Rochester, MN, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. · Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA. ·J Crohns Colitis · Pubmed #31960900.

ABSTRACT: BACKGROUND AND AIMS: Our goal was to determine the importance of ileal inflammation at computed tomography or magnetic resonance enterography in Crohn's disease patients with normal ileoscopy. METHODS: Patients with negative ileoscopy and biopsy within 30 days of CT or MR enterography showing ileal inflammation were included. The severity [0-3 scale] and length of inflammation within the distal 20 cm of the terminal ileum were assessed on enterography. Subsequent medical records were reviewed for ensuing surgery, ulceration at ileoscopy, histological inflammation, or new or worsening ileal inflammation or stricture on enterography. Imaging findings were classified as: Confirmed Progression [subsequent surgery or radiological worsening, new ulcers at ileoscopy or positive histology]; Radiologic Response [decreased inflammation with medical therapy]; or Unlikely/Unconfirmed Inflammation. RESULTS: Of 1471 patients undergoing enterography and ileoscopy, 112 [8%] had imaging findings of inflammation with negative ileoscopy, and 88 [6%] had negative ileoscopy and ileal biopsy. Half [50%; 44/88] with negative biopsy had moderate/severe inflammation at enterography, with 45%, 32% and 11% having proximal small bowel inflammation, stricture or fistulas, respectively. Two-thirds with negative biopsy [67%; 59/88] had Confirmed Progression, with 68%, 70% and 61% having subsequent surgical resection, radiological worsening or ulcers at subsequent ileoscopy, respectively. Mean length and severity of ileal inflammation in these patients was 10 cm and 1.6. Thirteen [15%] patients had Radiologic Response, and 16 [18%] had Unlikely/Unconfirmed Inflammation. CONCLUSION: Crohn's disease patients with unequivocal imaging findings of ileal inflammation at enterography despite negative ileoscopy and biopsy are likely to have active inflammatory Crohn's disease. Disease detected by imaging may worsen over time or respond to medical therapy.

17 Article Histopathology Scoring Systems of Stenosis Associated With Small Bowel Crohn's Disease: A Systematic Review. 2020

Gordon, Ilyssa O / Bettenworth, Dominik / Bokemeyer, Arne / Srivastava, Amitabh / Rosty, Christophe / de Hertogh, Gert / Robert, Marie E / Valasek, Mark A / Mao, Ren / Kurada, Satya / Harpaz, Noam / Borralho, Paula / Pai, Reetesh K / Pai, Rish K / Odze, Robert / Feakins, Roger / Parker, Claire E / Nguyen, Tran / Jairath, Vipul / Baker, Mark E / Bruining, David H / Fletcher, J G / Feagan, Brian G / Rieder, Florian / Anonymous1981084. ·Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio. · Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany. · Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Clinical Pathology, The University of Melbourne, Parville, Victoria, Australia; Envoi Specialist Pathologists, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. · Department of Pathology, University Hospital Leuven, Leuven, Belgium. · Department of Pathology, Yale University School of Medicine, New Haven, Connecticut. · Department of Pathology, University of California San Diego, La Jolla, California. · Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio. · Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio. · Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. · Faculdade de Medicina da Universidade de Lisboa, Instituto de Anatomia Patológica, Lisbon, Portugal. · Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona. · Pathology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Cellular Pathology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom. · Robarts Clinical Trials, Inc, London, Ontario, Canada. · Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada. · Department of Diagnostic Radiology, Imaging Institute, Digestive Diseases and Surgery Institute, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota. · Department of Radiology, Mayo Clinic, Rochester, Minnesota. · Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: riederf@ccf.org. ·Gastroenterology · Pubmed #31476299.

ABSTRACT: BACKGROUND & AIMS: Stenosis is a common complication of Crohn's disease (CD) that has no effective medical therapy. Development of antifibrotic agents will require testing in randomized controlled trials. Computed tomography enterography- and magnetic resonance enterography-based technologies might be used to measure outcomes in these trials. These approaches have been validated in studies of patients with symptomatic strictures who underwent imaging evaluations followed by resection with histopathologic grading of the intestinal tissue for inflammation and/or fibrosis (the reference standard). Imaging findings have correlated with findings from quantitative or semiquantitative histologic evaluation of the degree of fibromuscular stenosis and/or inflammation on the resection specimen. However, it is not clear whether histologic findings are an accurate reference standard. We performed a systematic review of all published histologic scoring systems used to assess stenosing CD. METHODS: We performed a comprehensive search of Embase and MEDLINE of studies through March 13, 2019, that used a histologic scoring system to characterize small bowel CD and assessed inflammatory and fibrotic alterations within the same adult individual. All scores fitting the criteria were included in our analysis, independent of the presence of stricturing disease, as long as inflammation and fibrosis were evaluated separately but in the same scoring system. RESULTS: We observed substantial heterogeneity among the scoring systems, which were not derived from modern principles for evaluative index development. None had undergone formal validity or reliability testing. None of the existing indices had been constructed according to accepted methods for the development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices for evaluating the important pathologic component of myofibroblast hypertrophy or hyperplasia have not been proposed. CONCLUSIONS: In a systematic review of publications, we found a lack of validated histopathologic scoring systems for assessment of fibromuscular stenosis. Data that describe the operating properties of existing cross-sectional imaging techniques for stenosing CD should be questioned. Development and validation of a histopathology index is an important research priority.

18 Article Impact of Bariatric Surgery on the Long-term Disease Course of Inflammatory Bowel Disease. 2019

Braga Neto, Manuel B / Gregory, Martin H / Ramos, Guilherme P / Bazerbachi, Fateh / Bruining, David H / Abu Dayyeh, Barham K / Kushnir, Vladimir M / Raffals, Laura E / Ciorba, Matthew A / Loftus, Edward V / Deepak, Parakkal. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA. · Washington University Inflammatory Bowel Diseases Center, Saint Louis, Missouri, USA. ·Inflamm Bowel Dis · Pubmed #31613968.

ABSTRACT: BACKGROUND: An association between inflammatory bowel disease (IBD) and obesity has been observed. Little is known about the effect of weight loss on IBD course. Our aim was to determine the impact of bariatric surgery on long-term clinical course of obese patients with IBD, either Crohn's disease (CD) or ulcerative colitis (UC). METHODS: Patients with IBD who underwent bariatric surgery subsequent to IBD diagnosis were identified from 2 tertiary IBD centers. Complications after bariatric surgery were recorded. Patients were matched 1:1 for age, sex, IBD subtype, phenotype, and location to patients with IBD who did not undergo bariatric surgery. Controls started follow-up at a time point in their disease similar to the disease duration in the matched case at the time of bariatric surgery. Inflammatory bowel disease medication usage and disease-related complications (need for corticosteroids, hospitalizations, and surgeries) among cases and controls were compared. RESULTS: Forty-seven patients met inclusion criteria. Appropriate matches were found for 25 cases. Median follow-up among cases (after bariatric surgery) and controls was 7.69 and 7.89 years, respectively. Median decrease in body mass index after bariatric surgery was 12.2. Rescue corticosteroid usage and IBD-related surgeries were numerically less common in cases than controls (24% vs 52%; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.08-1.23; 12% vs 28%; OR, 0.2; 95% CI, 0.004-1.79). Two cases and 1 control were able to discontinue biologics during follow-up. CONCLUSIONS: Inflammatory bowel disease patients with weight loss after bariatric surgery had fewer IBD-related complications compared with matched controls. This observation requires validation in a prospective study design.

19 Article Development of an Objective Model to Define Near-Term Risk of Ileocecal Resection in Patients with Terminal Ileal Crohn Disease. 2019

Grass, Fabian / Fletcher, Joel G / Alsughayer, Ahmad / Petersen, Molly / Bruining, David H / Bartlett, David J / Mathis, Kellie L / Lightner, Amy L. ·Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. · Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA. · Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA. ·Inflamm Bowel Dis · Pubmed #31050733.

ABSTRACT: BACKGROUND: The decision to either escalate medical therapy or proceed to ileocecal resection (ICR) in patients with terminal ileal Crohn disease (CD) remains largely subjective. We sought to develop a risk score for predicting ICR at 1 year from computed tomography or magnetic resonance enterography (CTE/MRE). METHODS: We conducted a retrospective cohort study including all consecutive adult (> 18 years) patients with imaging findings of terminal ileal CD (Montreal classification: B1, inflammatory predominant; B2, stricturing; or B3, penetrating) on CTE/MRE between January 1, 2016, and December 31, 2016. The risk for ICR at 6 months and at 1 year of CTE/MRE and risk factors associated with ICR, including demographics, CD-specific immunosuppressive therapeutics, and disease presentation at the time of imaging, were determined. RESULTS: Of 559 patients, 121 (21.6%) underwent ICR during follow-up (1.4 years [IQR 0.21-1.64 years]); the risk for ICR at 6 months and at 1 year was 18.2% (95% CI 14.7%-21.6%) and 20.5% (95% CI 16.8%-24.1%), respectively. Multivariable analysis revealed Montreal classification (B2, hazard ratio [HR] 2.73, and B3, HR 6.80, both P < 0.0001), upstream bowel dilation (HR 3.06, P < 0.0001), and younger age (19-29 years reference, 30-44 years, HR 0.83 [P = 0.40]; 45-59 years, HR 0.58 [P = 0.04], and 60+ years, HR 0.45 [P = 0.01]) to significantly increase the likelihood of ICR. A predictive nomogram for interval ICR was developed based on these significant variables. CONCLUSIONS: The presence of CD strictures, penetrating complications, and upstream bowel dilation on CTE/MRE, combined with young age, significantly predict ICR. The suggested risk model may facilitate objective therapeutic decision-making.

20 Article Clinical Benefit of Capsule Endoscopy in Crohn's Disease: Impact on Patient Management and Prevalence of Proximal Small Bowel Involvement. 2018

Hansel, Stephanie L / McCurdy, Jeffrey D / Barlow, John M / Fidler, Jeff / Fletcher, Joel G / Becker, Brenda / Prabhu, Nayantara Coelho / Faubion, William A / Hanson, Karen A / Kane, Sunanda V / Kisiel, John B / Loftus, Edward V / Papadakis, Konstantinos A / Pardi, Darrell S / Raffals, Laura E / Schoenoff, Shayla / Tremaine, William J / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. ·Inflamm Bowel Dis · Pubmed #29788055.

ABSTRACT: Background: Ileocolonoscopy and computed tomography (CT) or magnetic resonance (MR) enterography (CTE/MRE) are utilized to evaluate patients with small bowel (SB) Crohn's disease (CD). The purpose of our study was to estimate the impact of capsule endoscopy (CE) on patient management after clinical assessment, ileocolonoscopy, and CTE/MRE. Methods: We prospectively analyzed 50 adult CD patients without strictures at clinically indicated ileocolonoscopy and CTE/MRE exams. Providers completed pre- and post-CE clinical management questionnaires. Pre-CE questionnaire assessed likelihood of active SBCD and management plan using a 5-point level of confidence (LOC) scales. Post-CE questionnaire assessed alteration in management plans and contribution of CE findings to these changes. A change of ≥2 on LOC scale was considered clinically meaningful. Results: Of the 50 patients evaluated (60% females), median age was 38 years, median disease duration was 3 years, and median Crohn's Disease Activity Index (CDAI) score was 238 points. All CTE/MRE studies were negative for proximal disease. CE detected proximal disease in 14 patients (28%) with a median Lewis score of 215 points. CE findings altered management in 17 cases (34%). The most frequent provider-perceived benefits of CE were addition of new medication (29%) and exclusion of active SB mucosal disease (24%). Conclusion: CE is a safe imaging modality that alters clinical management in patients with established SBCD by adding incremental information not available at ileocolonoscopy and cross-sectional enterography.

21 Article Real-time Interobserver Agreement in Bowel Ultrasonography for Diagnostic Assessment in Patients With Crohn's Disease: An International Multicenter Study. 2018

Calabrese, Emma / Kucharzik, Torsten / Maaser, Christian / Maconi, Giovanni / Strobel, Deike / Wilson, Stephanie R / Zorzi, Francesca / Novak, Kerri L / Bruining, David H / Iacucci, Marietta / Watanabe, Mamoru / Lolli, Elisabetta / Chiaramonte, Carlo / Hanauer, Stephen B / Panaccione, Remo / Pallone, Francesco / Ghosh, Subrata / Monteleone, Giovanni. ·Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy. · Department of Internal Medicine and Gastroenterology, Staedtisches Klinikum Lueneburg, Lueneburg, Germany. · Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany. · Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy. · University Hospital Erlangen, Erlangen, Germany. · Department of Radiology and **Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Japan. · Institute of Translational of Medicine, University of Birmingham, Birmingham, UK. · Northwestern University Feinberg School of Medicine, Digestive Disease Center, Chicago, Illinois, USA. ·Inflamm Bowel Dis · Pubmed #29718450.

ABSTRACT: BACKGROUND: The unavailability of standardized parameters in bowel ultrasonography (US) commonly used in Crohn's disease (CD) and the shortage of skilled ultrasonographers are 2 limiting factors in the use of this imaging modality around the world. The aim of this study is to evaluate interobserver agreement among experienced sonographers in the evaluation of bowel US parameters in order to improve standardization in imaging reporting and interpretation. METHODS: Fifteen patients with an established diagnosis of CD underwent blinded bowel US performed by 6 experienced sonographers. Prior to the evaluation, the sonographers and clinical and radiological IBD experts met to formally define the US parameters. Interobserver agreement was tested with the Quatto method (s). RESULTS: All operators agreed on the presence/absence of CD lesions and distinguished absence of/mild activity or moderate/severe lesions in all patients. S values were moderate for bowel wall thickness (s = 0.48, P = n.s.), bowel wall pattern (s = 0.41, P = n.s.), vascularization (s = 0.52, P = n.s.), and presence of lymphnodes (s = 0.61, P = n.s.). Agreement was substantial for lesion location (s = 0.68, P = n.s.), fistula (s = 0.74, P = n.s.), phlegmon (s = 0.78, P = 0.04), and was almost perfect for abscess (s = 0.95, P = 0.02). Poor agreement was observed for mesenteric adipose tissue alteration, lesion extent, stenosis, and prestenotic dilation. CONCLUSIONS: In this study, the majority of the US parameters used in CD showed moderate/substantial agreement. The development of shared US imaging interpretation patterns among sonographers will lead to improved comparability of US results among centers and facilitate the development of multicenter studies and the spread of bowel US training, thereby allowing a wider adoption of this useful technique.

22 Article Outcomes of Endoscopic Therapy for Luminal Strictures in Crohn's Disease. 2018

Shivashankar, Raina / Edakkanambeth Varayil, Jithinraj / Scott Harmsen, W / Faubion, William A / Wong Kee Song, Louis M / Bruining, David H / Schroeder, Kenneth W / Kisiel, John / Loftus, Edward V / Coelho Prabhu, Nayantara. ·Divisions of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota. · Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania. · Division of Family Medicine, University of Illinois, Rockford, Illinois. · Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #29718220.

ABSTRACT: Backgrounds: We sought to describe the outcomes of endoscopic therapy of luminal strictures in patients with Crohn's disease (CD) at a large tertiary referral center. Methods: All patients who had undergone endoscopic dilation of CD strictures between January 1, 1990 and November 30, 2013 were identified. Demographics, disease characteristics including medication use and history of surgeries, details of endoscopic procedures, and long-term outcomes were analyzed. A successful procedure was defined as ability of the endoscope to pass through the stricture after dilation or effacement of the dilating balloon under fluoroscopy. Kaplan-Meier and Cox proportional hazards analysis were used. Results: For this study 286 index procedures for CD-related stricture dilation were performed in 273 patients (53.8% women) with median age of 45.9 years (range, 14.9-92.2). The most common stricture locations were ileocolonic anastomosis (36.4%) and colon (13.9%). One hundred fourteen (41.8%) patients had a second dilation. The cumulative probability of need for a second dilation following the index procedure was 33.6% at 1 year (95% CI, 25.9%-38.7%), 53.9% at 3 years (45.9%-61.2%), and 60.2% at 5 years (51.4%-67.5%). Six adverse events occurred after the first procedure: 4 perforations, 1 patient with bleeding, and 1 patient with abdominal pain requiring hospitalization. A total of 82 (30%) patients required surgery for their stricture. Conclusions: In a large cohort, endoscopic stricture dilation in CD was safe and effective. About 33% of patients required a second dilation at 1 year after the initial dilation; younger age and smaller inner diameter of the index stricture predicted need for a second dilation. 10.1093/ibd/izy049_video1izy049.video15794820307001.

23 Article Predictors of Durability of Radiological Response in Patients With Small Bowel Crohn's Disease. 2018

Deepak, Parakkal / Fletcher, Joel G / Fidler, Jeff L / Barlow, John M / Sheedy, Shannon P / Kolbe, Amy B / Harmsen, William S / Therneau, Terry / Hansel, Stephanie L / Becker, Brenda D / Loftus, Edward V / Bruining, David H. ·Division of Gastroenterology and Hepatology, Rochester, Minnesota. · Division of Abdominal Imaging, Rochester, Minnesota. · Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #29668921.

ABSTRACT: Background: The long-term significance of radiological transmural response (TR) as a treatment goal at the first follow-up scan in small bowel Crohn's disease (CD) has been previously shown. We examined the durability of a long-term strategy of treating to a target of radiological TR and the influence of baseline predictors on the maintenance of TR. Methods: Small bowel CD patients between January 1, 2002, and December 31, 2014, were identified with serial computed tomography enterography (CTE)/magnetic resonance enterography (MRE) before and after initiation of therapy or on maintenance therapy. Overall TR (inflammatory lesions with/without strictures) w1as characterized by abdominal radiologists in up to 5 small bowel lesions per patient at each serial scan until last follow-up or small bowel resection, as response, partial response, or nonresponse. The rate of conversion between TR states and transition to surgery, including the effect of baseline patient/disease characteristics, was examined using a multistate model (mstate R-package). Results: CD patients (n = 150, 705 CTE/MRE) with a median of 4 CTE/MRE during 4.6 years of follow-up, 49% with ileal-only distribution, had 260 examined bowel segments. Conversion from response to partial response/nonresponse was 37.4% per year of follow-up with no transitions seen directly from response to surgery. Current smoking status (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.1-4.3) and internal penetrating disease at baseline scan (HR, 2.2; 95% CI, 1.2-4.1) were associated with a 2-fold increased risk of transition from partial response/nonresponse to surgery. Conclusions: Achievement and maintenance of radiological response is associated with avoidance of small bowel surgery. Continued follow-up with CTE/MRE is recommended to identify loss of response, especially in current smokers and patients with internal penetrating disease at baseline CTE/MRE.

24 Article Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. 2018

Bruining, David H / Zimmermann, Ellen M / Loftus, Edward V / Sandborn, William J / Sauer, Cary G / Strong, Scott A / Anonymous5540932. ·From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L) · Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.) · Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S) · Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S) · and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S). ·Radiology · Pubmed #29319414.

ABSTRACT: Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented.

25 Article De-novo Inflammatory Bowel Disease After Bariatric Surgery: A Large Case Series. 2018

Braga Neto, Manuel B / Gregory, Martin / Ramos, Guilherme P / Loftus, Edward V / Ciorba, Matthew A / Bruining, David H / Bazerbachi, Fateh / Abu Dayyeh, Barham K / Kushnir, Vladimir M / Shah, Meera / Collazo-Clavell, Maria L / Raffals, Laura E / Deepak, Parakkal. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. · Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA. · Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA. ·J Crohns Colitis · Pubmed #29272375.

ABSTRACT: Background: Case reports of inflammatory bowel diseases [IBD] have been reported in patients with a history of bariatric surgery. Our aim was to characterize patients who were diagnosed with IBD after having undergone bariatric surgery. Methods: Electronic medical records were reviewed at two institutions to identify patients who developed de-novo Crohn's disease or ulcerative colitis [UC] after bariatric surgery. Data on demographics, type of bariatric surgical procedure, IBD subtype, phenotype and medication usage were obtained. The incidence rate of de-novo IBD after bariatric surgery [per 100000 person-years] and standardized incidence ratio [SIR] were estimated from a prospective bariatric surgery database. Results: A total of 44 patients with de-novo IBD after bariatric surgery were identified [31 Crohn's disease, 12 UC, one IBD unclassified]. Most patients were female [88.6%], with median age at IBD onset of 44 years [IQR, 37-52] and median time to IBD diagnosis after bariatric surgery of 7 years [IQR, 3-10]. Sixty-eight per cent underwent Roux-en-Y gastric bypass. In the prospective database, the incidence of IBD in patients who underwent bariatric surgery was 26.7 per 100000 person-years [4.5 for UC and 22.3 for Crohn's disease]. The age-adjusted SIR ranged from 3.56 in the 40-49 year age group to 4.73 in the 30-39 year age group. Conclusion: We described a case series of patients developing de-novo IBD after bariatric surgery. There appears to be a numerically higher incidence of Crohn's disease in this population. Confirmation of causality is required in larger patient cohorts.

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