What question did this study set out to answer?

This study aims to evaluate whether intestinal ultrasound and leucine-rich α-2 glycoprotein can predict relapse in Crohn’s disease patients with normal C-reactive protein levels.

January 23, 2026

P0887Intestinal Ultrasound and Leucine-Rich α-2 Glycoprotein as Predicters of Relapse in Crohn’s Disease Patients with Normal CRP

Key Points

This study aims to evaluate whether intestinal ultrasound and leucine-rich α-2 glycoprotein can predict relapse in Crohn’s disease patients with normal C-reactive protein levels.
Conducted a single-centre retrospective observational study
Enrolled Crohn’s disease patients from 2019 to 2024
Tested paired intestinal ultrasound and leucine-rich α-2 glycoprotein assessments
Utilized log-rank tests and Cox proportional hazards models for predictive analysis
117 intestinal ultrasound assessments performed in 78 patients; 38 relapsed (32%)
Significant differences in relapse-free survival were identified
Only C-reactive protein remained significant in multivariable analysis (P = 0.02)
Optimal cut-off values determined as 24 for IBUS-SAS and 13 for LRG
In patients with baseline CRP < 0.13 mg/dL, both LRG and IBUS-SAS were significant predictors

Abstract

Abstract Background Endoscopy is commonly used to assess disease activity in Crohn’s disease (CD), but it is invasive and limited to mucosal evaluation. We investigated whether intestinal ultrasound (IUS) and leucine-rich α-2 glycoprotein (LRG) can predict relapse in CD and support treat-to-target monitoring. Methods This single-centre retrospective observational study enrolled CD patients from 2019 to 2024 who underwent paired IUS and LRG testing. Relapse within the 1-year observation period was defined as treatment escalation, hospitalisation, or surgery. The predictive performance of C-reactive protein (CRP), IUS assessed using the international bowel ultrasound segmental activity score (IBUS-SAS), and LRG was evaluated using log-rank tests and Cox proportional hazards models. Hazard ratios (HRs) per one-unit increase in IBUS-SAS and LRG were also calculated using Cox models. Cut-off values for CRP, IBUS-SAS, and LRG were derived from receiver operating characteristic (ROC) analysis using the Youden Index and used for stratified analyses. Results A total of 117 IUS assessments were performed in 78 patients; 38 (32%) relapsed. Kaplan–Meier analysis demonstrated significant differences in relapse-free survival according to CRP, IBUS-SAS, and LRG. In Cox models, all three markers were significant predictors in univariable analysis (all P 0.05), but only CRP remained significant in the multivariable model (P = 0.02; Table 1). The optimal cut-off values were 24 for IBUS-SAS and 13 for LRG. In univariable Cox proportional hazards analyses restricted to patients with baseline CRP 0.13 mg/dL, both LRG (HR 9.76; 95% CI = 1.17–81.2) and IBUS-SAS (HR 5.53; 95% CI = 1.07–28.5) were significant predictors, as reflected by Kaplan–Meier curves (Figure 1). Conclusion LRG, IBUS-SAS, and CRP each predict relapse in CD. Both LRG and IBUS-SAS can stratify relapse risk even when CRP is negative, supporting their combined use to monitor transmural inflammation and guide timely treatment optimisation. Conflict of interest: Ms. Inoue, Nanako: No conflict of interest Sagami, Shintaro: Shintaro Sagami has served as an advisory board member, consultant, or speaker for AbbVie, Alimentiv, Bristol Myers Squibb, Celltrion, EA Pharma, Eli Lilly, Ferring Pharmaceuticals, Gilead Sciences, Janssen Pharmaceuticals, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Takeda, and Zeria Pharmaceutical, and has received research funding from Bristol Myers Squibb, EA Pharma, Gilead Sciences, Helmsley Charitable Trust, JIMRO, Kyorin Pharmaceutical, Miyarisan, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Sekisui Medical, Samsung, Takeda, and Zeria Pharmaceutical. Komatsu, Moeko: No conflict of interest Asonuma, Kunio: Kunio Asonuma has served as a speaker for AbbVie, Takeda Pharmaceutical, Mochida Pharmaceutical, EA Pharma, Pfizer, Mitsubishi-Tanabe Pharma, and KISSEI PHARMACEUTICAL CO., LTD. Nogami, Akira: Akira Nogami has received speaking fees from Abbvie GK and Mochida Pharmaceutical. Shibui, Shunsuke: Shunsuke Shibui has received speaking fees from Abbvie GK and Mochida Pharmaceutical. Suzuki, Keita: No conflict of interest Nakamura, Kenta: No conflict of interest Umeda, Satoko: No conflict of interest Matsubayashi, Mao: No conflict of interest Nakano, Masaru: Masaru Nakano has received speaker or consultancy fees from Covidien, Mochida Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Zeria Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and Nippon Kayaku Co., Ltd. and research funding from Mitsubishi Tanabe Pharma Corporation and the Japanese Foundation for Research and Promotion of Endoscopy. Kobayashi, Taku: Grant: AbbVie, Alfresa Pharma, Bristol Myers Squibb, Celtrion, EA Pharma, Gilead Sciences, Kyorin Pharmaceutical, Miyarisan, Mochida Pharmaceutical, Nippon Kayaku, Otsuka Holdings, Pfizer, Sekisui Medical, Takeda, Zeria Pharmaceutical Personal Fees: AbbVie, Alfresa Pharma, Alimentiv, Bristol Myers Squibb, Celltrion, Covidien, EA Pharma, Eli Lilly, Ferring Pharmaceuticals, Galapagos, Gilead Sciences, Janssen, JIMRO, Kissei Pharmaceutical, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, MSD, Nippon Kayaku, Pfizer, Sekisui Medical, Takeda Pharmaceutical, Zeria Pharmaceutical

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