Measuring disease activity in Crohn’s disease: what is currently available to the clinician

Figures & data

Table 1 Advantages and disadvantages of endoscopic techniques for monitoring Crohn’s disease activity

Advantages	Disadvantages
Ileocolonoscopy
• Direct evaluation of mucosal healing	• Invasiveness
	• Bowel preparation
• Possibility of mucosal sampling for histology	• Costs
	• No transmural evaluation
• Validated scores of severity (CDEIS/SES-CD/Rutgeerts Score)	• No visualization of proximal ileum
• Predictive of risk of	• Controversial definition of mucosal healing (partial versus complete healing of the mucosa)
– Relapse
– Refractoriness to medical therapy
– Surgery
– Postoperative recurrence
Small bowel capsule endoscopy
• Complete visualization of the small bowel mucosa	• Scores of severity need further validation in larger cohort of patients
• Less invasive than conventional endoscopy	• No mucosal sampling for histology
• High diagnostic yield for small mucosal lesions	• Costs
• Recent validation of scores of severity (Niv and Lewis)	• Bowel preparation
	• No transmural evaluation
	• Not widely available

Abbreviations: CDEIS, Crohn’s Disease Endoscopic Index of Severity; SES-CD, Simple Endoscopic Score for Crohn’s Disease.

Table 2 Advantages and disadvantages of cross-sectional imaging techniques for monitoring Crohn’s disease activity

Advantages	Disadvantages
MRI
• Evaluation of small bowel and colon	• Costs
	• Time consuming
• Perianal evaluation	• Not widely available
• Assessment of transmural and extramural activity	• Requires bowel distension with oral and/or rectal contrast
• Validated scores of activity (MaRIA/CDMI)	• Requires intravenous contrast medium
• Radiation free
CT
• Evaluation of small bowel and colon	• Radiation exposure
	• No validated scores
• Assessment of transmural and extramural activity	• Requires bowel distension with oral and/or rectal contrast
• Widely available	• Requires intravenous contrast medium
US
• Evaluation of terminal ileum and colon	• Limited assessment of proximal ileum, jejunum, transverse colon, rectum
• Assessment of transmural and extramural activity
	• Limited by gas filled bowel, obesity
• Radiation free
• Noninvasive	• Accuracy is dependent on the experience of the sonologist
• Possibility to use Doppler and Contrast Enhanced techniques
	• Score of activity (SLIC) needs further validation

Abbreviations: CDMI, Crohn’s Disease MRI Index; CT, computed tomography; MaRIA, Magnetic Resonance Index of Activity; MRI, magnetic resonance imaging; SLIC, sonographic lesion index for CD; US, ultrasound.