P0361Non-invasive assessment of structural damage and degree of fibrosis in Crohn’s disease using intestinal ultrasound with elastography

Abstract Background Crohn’s disease (CD) is a chronic inflammatory bowel disease that may lead to the development of often irreversible structural bowel damage (SBD). The presence of complications detectable through imaging techniques, such as strictures, fistulas, or abscesses, is widely accepted to describe SBD. The development of these complications is associated with intestinal wall fibrosis, which generally reduces responsiveness to medical treatment. Identifying fibrosis severity in complicated CD patients and accurately characterizing SBD could enhance disease management. Intestinal ultrasound with shear-wave elastography (IUS-E) offers a non-invasive method to assess fibrosis, though its clinical use is still limited. The primary objective was to assess whether patients with CD and complications such as strictures, fistulas, and/or abscesses present a higher degree of intestinal wall fibrosis, as measured by IUS-E, compared to patients with an inflammatory pattern. Methods A cross-sectional observational study was conducted, including consecutively enrolled patients with CD managed at the IBD Unit of Dr. Peset University Hospital, who had a clinical indication for intestinal ultrasound. Descriptive statistics were calculated to summarize the characteristics of the study population. Subsequently, intestinal wall features (wall thickness, degree of hyperemia assessed by Doppler, presence of complications, and degree of fibrosis by elastography) were compared between patients with transmural complications (strictures, abscesses, and/or fistulas) and those with an inflammatory pattern. Results In this preliminary analysis, a total of 54 patients with Crohn’s disease were included: 33 (61.1%) with an inflammatory pattern and 21 (38.9%) with transmural complications. The median bowel wall stiffness was significantly higher in the complicated group (10.2 kPa) versus the inflammatory group (7.9 kPa). Complicated patients also had greater bowel wall thickness (7 mm vs. 5.5 mm; p 0.003) (Table 1). However, when stratified by phenotype (Table 2), statistically significant differences were only found between the inflammatory and penetrating phenotypes in bowel wall stiffness assessed by IUS-E and bowel wall thickness. Conclusion Together, these findings support the association between fibrosis and the development of transmural complications in Crohn’s disease, as well as the potential of IUS-E as a non-invasive tool for characterizing structural damage and the degree of fibrosis in Crohn’s disease. Its ability to differentiate between inflammatory and complicated forms could significantly contribute to individualized therapeutic decision-making. Conflict of interest: Dr. Albert Palomares, Sara: No conflict of interest Marques Garcia, Pilar: No conflict of interest Fquihi Chetouani, Mohammed: No conflict of interest García Peiró, Empar: No conflict of interest Rabadán Mata, Alba: No conflict of interest Martínez Pérez, María Jesús: No conflict of interest Blanc García, Esther: No conflict of interest Paredes Arquiola, Jose Maria: No conflict of interest