Intestinal ultrasound score predicts therapeutic outcomes of infliximab in pediatric patients with Crohn’s disease

Abstract

Background and aims

Objective evaluation of treatment response is critical in the management of Crohn’s disease (CD). Compared with endoscopy, intestinal ultrasound (IUS) is non-invasive and well-tolerated. This study is aimed to assess the predictive value of IUS score for treatment response in pediatric CD patients.

Methods

We conducted a retrospective study in pediatric CD patients who underwent endoscopy and IUS at start of infliximab treatment [T0] and after 22–38 weeks [T1] between February 2021 and January 2023. Pediatric Crohn’s Disease Activity Index (PCDAI), biochemical parameters, the Simple Endoscopic Score for Crohn’s disease (SES-CD) and IUS parameters were collected at two timepoints. IUS scores were assessed by International Bowel Ultrasound Segment Activity Score (IBUS-SAS).

Results

Thirty patients were included, with 53.3% reaching endoscopic response and 43.3% endoscopic remission. After infliximab treatment, IBUS-SAS (58.5 ± 24.2 vs 34.4 ± 21.6, p = .0001) was significantly decreased. At T1, change in IBUS-SAS (−38.2 ± 22.0 vs −7.9 ± 24.1, p = .0015) were pronounced in patients with endoscopic response compared with endoscopic non-response. Significant correlation were observed between IBUS-SAS and SES-CD, PCDAI, C-reaction protein, erythrocyte sedimentation rate, hemoglobin, albumin. The most accurate cutoff values for predicting endoscopic response were 57.4% decrease of IBUS-SAS (AUROC: 0.862, p < .001). The optimal cut-off of IBUS-SAS to correlate endoscopic remission was 26.0 (AUROC: 0.686, p = .017).

Conclusions

The validated ultrasound-base score, IBUS-SAS is an effective index for monitoring endoscopic response to infliximab therapy in CD. IUS evaluation could guide treatment decision for pediatric CD.

Keywords:

• Intestinal ultrasound
• Crohn’s disease
• children
• treatment response
• infliximab

Acknowledgements

We would like to thank all the patients and their parents for supporting this study.

Author contributions

Wang L collected and analyzed the data, and drafted the manuscript. Zhang Y performed intestinal ultrasound examinations and record the parameters. Wu HL completed the patients’ enrollment. Tang ZF and Wang YH performed the endoscopy examination. Wang YH and Huang Y developed the study design and revised the manuscript. All authors approved the final version of the manuscript.

Ethics statement

We conducted the study following the Declaration of Helsinki. This study was approved by the Ethics Committee of the Children’s hospital of Fudan University. All patients’ guardians gave written informed consent.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by Shanghai Science and Technology Development Foundation under grant number 22QA1401400 and Shanghai Municipal Health Commission under grant number 202340216.