Enterorressonância na doença de Crohn: correlação com a atividade clínica da doença e impacto no tratamento

Abstract

Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, being one of the two main categories of Inflammatory Bowel Disease. The small intestine is involved in about 70% of cases of Crohn's disease and is not easily accessible by conventional endoscopic methods. Due to the absence of ionizing radiation and increased tissue contrast, magnetic resonance enterography (MRE) has become an important modality of radiological examination in the evaluation of CD. The main objective of this study was to correlate MRE parameters with clinical, endoscopic and laboratory variables. The secondary objective of this study was to evaluate the occurrence of change in medical conduct after MRE. This study was retrospective, unicentric and transverse. Patients with a diagnosis of CD established by clinical, endoscopic and histological criteria with medical records at the Inflammatory Bowel Disease Outpatient Clinic of Pedro Ernesto University Hospital / Piquet Carneiro Clinic were included in the study, submitted to MRE and ileocolonoscopy with interval of up to 30 days between January 2011 and December 2013. The review of medical records included the collection of clinical data, ileocolonoscopy, CD activity grade in the Harvey Bradshaw Index and laboratory tests. The MRE technique included images of the abdomen acquired before and after the administration of venous contrast. Patients' examinations were first divided into five patterns: normal, exclusively inflammatory, penetrating, fibro-stenosing and mixed patterns. Subsequently, an analysis was performed with altered MREs divided into three groups: presence of inflammatory, penetrating or fibroestenosing criteria. A total of 74 patients, 41 women and 33 men, were included in the study and each patient underwent MRE. The median age was 45.5 years (range 33.7-58), and the median duration of disease before MRE was 7.5 years (range of 4.7-15.3). Changes in medical management were recorded in 31 (41.9%) of the patients, and were significantly associated with disease patterns in MRE. There was a statistically significant change in medical decision in individuals with a purely penetrating pattern (p = 0.012). The influence of a mixed pattern on MRE (p = 0.024) in medical decision was statistically significant. Patients with normal MRE pattern had a statistically significant correlation with unchanged medical decision (p = 0.001). There was a statistically significant agreement between absence of inflammatory criteria in MRE and remission in HBI (p = 0.037) and a statistically significant correlation between the presence of inflammatory criteria in MRE and positive calprotectin (p = 0.005). There was also agreement between penetrating criteria in MRE and SESCD, indicating active disease (p = 0.048). Finally, there was a significant agreement between presence of fibrostatic criteria and a longer duration disease (p = 0.027). This study showed that the absence of symptoms does not have a good correlation with disease remission in MRE, confirming the need to perform this test in the follow-up of the patient with small bowel’s CD. On the other hand, calprotectin has a good association with the presence of inflammatory criteria in MRE and can be usedalternately to radiological examination in the follow-up of patients. Prolonged disease duration is associated with evolution to fibrostenosing phenotype, a complication frequently only detected in the imaging exam. Our study concluded that the outcome of MRA has an impact on medical conduct and that clinical remission by HBI is not a good predictor of remission in MRA, although fecal calprotectin has a good correlation with MRA activity.