Background The assessment of treatment response in patients with Inflammatory Bowel Disease (IBD) is often based on clinical indices [Harvey Bradshaw index (HBI), Partial Mayo score (PMS)] and biomarkers [C - reactive protein (CRP)]. Intestinal ultrasound (IUS) has been proposed as a modality capable of objectively evaluating therapeutic response. We investigated the utility of the IUS as a tool to assess treatment response, as well as its association with HBI, PMS and CRP. Methods We included patients with an established diagnosis of IBD who initiated biologic agent (infliximab, adalimumab, ustekinumab, vedolizumab) or tofacitinib. Active disease on IUS was defined as an increase in bowel wall thickness (BWT) >3 mm in the most affected bowel segment, while the presence of a Doppler signal (CDS) in the bowel wall was also assessed. Treatment response on IUS was defined according to the International Bowel Ultrasound Group (IBUS) criteria: reduction in bowel wall thickness (in continuous measurements) >25% or >2.0 mm or >1.0 mm with concomitant reduction in CDS by 1 unit at week 14 ± 2 from the initiation of treatment. Results A total of 19 patients (11 men, 11 with Crohn's disease) underwent IUS at week 0 and week 14 ± 2, while CRP, HBI and PMS were calculated at the same time points. We included bio-naïve as well bio experienced patients (table 1). At week 0, 84.2% of patients exhibited clinical activity (HBI ≥5, PMS ≥2), median CRP was 24.7 mg /L (IQR 18.6-42.8) and median BWT was 7.1mm (IQR 6.5-7.6). At week 14 ± 2, 42.1% of patients remained clinically active, median CRP was 6.8 mg/L (IQR 4.6-20.7) and median BWT was 5.2 mm (IQR 4.6- 6.4). Overall 10/19 patients fulfilled the criteria of treatment response on IUS at week 14 ± 2. Clinical remission was observed in 8/10 patients who demonstrated therapeutic response on IUS and 3/9 patients who did not (p=0.07). Normalization of CRP value (<6mg/L) was observed in 8/10 patients who exhibited treatment response on IUS and in none of the patients who did not (p<0.001). Among the IUS parameters at baseline, a statistically significant difference was found only in the presence of fat wrapping between treatment responders and treatment non-responders (table 2). Finally, median CRP was 4.9 mg/L (IQR 2.6-6.2) in IUS treatment responders and 20.7 mg/L (IQR 10.5-28.5) in IUS treatment non-responders. (p<0.001), with median BWT being 4.7mm (IQR 3.3-5.1) and 6.4mm (IQR 6.1-6.9) respectively (p<0.001). Conclusion IUS represents an objective tool for evaluating treatment response in patients with IBD, which demonstrates a significant correlation with CRP but not with clinical indices of activity.

中文翻译：

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P310 肠道超声作为评估炎症性肠病患者治疗反应的工具

背景 炎症性肠病 (IBD) 患者的治疗反应评估通常基于临床指标 [Harvey Bradshaw 指数 (HBI)、部分 Mayo 评分 (PMS)] 和生物标志物 [C - 反应蛋白 (CRP)]。肠道超声（IUS）已被提议作为一种能够客观评估治疗反应的方式。我们研究了 IUS 作为评估治疗反应的工具的效用，以及它与 HBI、PMS 和 CRP 的关联。方法 我们纳入了已确诊为 IBD 且开始使用生物制剂（英夫利昔单抗、阿达木单抗、乌特克单抗、维多珠单抗）或托法替尼的患者。IUS上的活动性疾病被定义为受影响最严重的肠段中肠壁厚度(BWT)增加＞3mm，同时还评估了肠壁中多普勒信号(CDS)的存在。IUS 的治疗反应根据国际肠道超声组 (IBUS) 标准定义：肠壁厚度减少（连续测量）>25% 或 >2.0 mm 或 >1.0 mm，同时 CDS 减少 1 个单位治疗开始后第 14 ± 2 周。结果共有19名患者（11名男性，11名克罗恩病患者）在第0周和第14±2周接受了IUS，同时计算了CRP、HBI和PMS。我们纳入了未进行过生物实验的患者以及经历过生物实验的患者（表 1）。第0周时，84.2%的患者表现出临床活动（HBI≥5，PMS≥2），中位CRP为24.7 mg/L（IQR 18.6-42.8），中位BWT为7.1mm（IQR 6.5-7.6）。在第 14 ± 2 周，42.1% 的患者仍处于临床活动状态，中位 CRP 为 6.8 mg/L (IQR 4.6-20.7)，中位 BWT 为 5.2 mm (IQR 4.6-6.4)。总体而言，10/19 名患者在第 14 ± 2 周时满足 IUS 治疗反应标准。8/10 名患者对 IUS 表现出治疗反应，3/9 名患者没有表现出临床缓解（p=0.07）。在对 IUS 表现出治疗反应的患者中有 8/10 观察到 CRP 值正常化(＜6mg/L)，而没有表现出治疗反应的患者中没有观察到 CRP 值正常化(p＜0.001)。在基线 IUS 参数中，仅在治疗有反应者和治疗无反应者之间存在脂肪包裹时才发现统计学显着差异（表 2）。最后，IUS 治疗有反应者的中位 CRP 为 4.9 mg/L (IQR 2.6-6.2)，IUS 治疗无反应者的中位 CRP 为 20.7 mg/L (IQR 10.5-28.5)。(p＜0.001)，中位BWT分别为4.7mm(IQR 3.3-5.1)和6.4mm(IQR 6.1-6.9)(p＜0.001)。结论 IUS 是评估 IBD 患者治疗反应的客观工具，它与 CRP 显着相关，但与临床活动指数无关。