DOP067Prognostic value of baseline intestinal ultrasound in patients with newly diagnosed Crohn’s disease: A prospective inception cohort study

Abstract Background In Crohn’s disease (CD), transmural inflammation is strongly linked to adverse long-term outcomes (1,2). It is unclear whether a “non-transmural disease” assessed by intestinal ultrasound (IUS) at diagnosis predicts a more favorable early disease course. We aimed to characterize baseline features and 1-year outcomes in an ongoing prospective inception cohort of patients with newly diagnosed CD, stratified by IUS findings at presentation. Methods Consecutively enrolled patients (May 2021–present), underwent baseline IUS assessment using the International Bowel Ultrasound segmental activity score (IBUS-SAS) (3). “Non-transmural disease” was defined a priori using an IBUS-SAS cutoff of 23.8 (4). Baseline comparisons included CDAI, CRP, faecal calprotectin, SES-CD, and recommendation to initiate biologic therapy. The composite 1-year outcome comprised any CD-related surgery, hospitalization, steroid dependence, or exposure to ≥ 2 biologics. In patients with paired IUS assessments (baseline and 1 year), within-patient changes in IBUS-SAS were evaluated. Results Of 117 patients with newly diagnosed CD, 91 (78%) had baseline IUS, 83 completed 1-year follow-up and 61 had follow-up IUS at 1 year. The 41.7% patients with “non-transmural disease” at baseline had significantly lower baseline CDAI (median IQR 155 86–226 vs 232 173–276); CRP (0.32 0.15–1.47 vs 2.53 1.01–4.87 mg/L); faecal calprotectin (309 104–749 vs 878 430–1860 μg/g); and SES-CD (6 4–13 vs 10 7–12) compared to those with active transmural disease. Recommendation for biologic initiation was less frequent (58% vs 89%), as was biologic start within 1 year (47% vs 79%). At 1 year, the composite complication rate was significantly lower in the “non-transmural disease” baseline IUS group (8.6% vs 29.2%; p = 0.03). In the paired IUS subset (n = 61), IBUS-SAS improved by a median of − 9.8 (−43.2–0) points. The most prominent improvement was observed in patients with active transmural disease at baseline (IBUS-SAS 23.8) (−39.0 −58.0–−19.2; p 0.001). Conclusion A “non-transmural disease” IUS (IBUS-SAS 23.8) at CD diagnosis identifies a substantial subgroup of patients with lower inflammatory burden, reduced early need for biologics, and markedly fewer 1-year complications. Incorporating routine IUS phenotyping at diagnosis may enhance early risk-stratification. References: 1.Fernandes SR, Rodrigues RV, Bernardo S, et al. Transmural healing is associated with improved long term outcomes in patients with Crohn’s disease. Inflammatory Bowel Diseases. 2017;23(8):1403-1409. doi:10.1097/MIB.0000000000001143 2.Castiglione F, Imperatore N, Testa A, et al. One year clinical outcomes with biologics in Crohn’s disease: Transmural healing compared with mucosal or no healing. Aliment Pharmacol Ther. 2019;49(8):1026-1039. doi:10.1111/apt.15190 3.Novak KL, Nylund K, Maaser C, et al. Expert consensus on optimal acquisition and development of the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS): A reliability and inter-rater variability study on intestinal ultrasonography in Crohn’s disease. Journal of Crohn’s and Colitis. 2021;15(4):609-616. doi:10.1093/ecco-jcc/jjaa216 4.Long X, Peng C, Zhang X, et al. Different imaging techniques’ diagnostic efficacy for Crohn’s disease activity and external validation and comparison of MDCTAs, SES-CD and IBUS-SAS. BMC Gastroenterol. 2024;24(1):277. doi:10.1186/s12876-024-03376-8 Conflict of interest: Banai Eran, Hagar: No conflict of interest Gal, Donna: No conflict of interest Sharar Fischler, Tali: No conflict of interest Ollech, Jacob: No conflict of interest Avni Biron, Irit: No conflict of interest Snir, Yifat: No conflict of interest Broitman, Yelena: No conflict of interest Friedenberg, Adi: No conflict of interest Pauker, Maor: No conflict of interest Dotan, Iris: Grant: The Leona M. and Harry B. Helmsley Charitable Trust, Altman Research, Pfizer, BMS Personal Fees: Pfizer, Falk, Ferring, Abbvie, Janssen, Celltrion, Takeda, Celgene/BMS, Gilead, Galapagos, Materia Prima, Sandoz, Sublimity, Sangamo, Spyre, Eli-Lilly, Harp Diagnostics, Gutreat, Astra Zeneca Yanai, Henit: Grant: Pfizer, ISF Personal Fees: AbbVie, Janssen, Pfizer, Takeda, Bristol Myers Squibb, and Elly Lilli.