Small bowel ultrasound predicts response to infliximab in pediatric CD

Use of small bowel ultrasound (SBUS) is a feasible, noninvasive tool to measure early treatment response to infliximab in children with Crohn’s disease (CD), suggests a study. Moreover, the first parameter to change is bowel wall hyperaemia (BWH), not bowel wall thickness.

“Inflammatory bowel disease management has shifted to a treat-to-target and tight control strategy utilizing noninvasive serum and faecal markers to monitor disease activity in response to therapy,” the authors said. “Bowel wall changes as seen on cross-sectional imaging may be a more accurate marker of treatment success.”

This study prospectively enrolled paediatric CD patients with small bowel involvement initiating infliximab. The authors evaluated clinical activity, biomarkers, and SBUS findings at baseline (T0) and postinduction at week 14 (T1).

The changes in SBUS parameters pre- and postinduction of infliximab and how they relate to clinical and biomarker response were the primary endpoints. Data were summarized through descriptive statistics, and associations were tested by univariate analysis.

After infliximab initiation, all 13 paediatric CD patients achieved steroid-free clinical remission (p<0.001) and a reduction in C-reactive protein (p=0.01). BWH (p=0.01) and bowel segment length involved (p=0.07) decreased postinduction.

At T1, the reduction in faecal calprotectin was moderately associated with a decrease in bowel segment length (r, 0.57; p=0.04). There was no association noted with a change in bowel wall thickness or BWH postinduction.

“Larger longitudinal studies are warranted to validate the utility of SBUS as part of a disease monitoring strategy,” the authors said.