Magnetic resonance enterography can predict the clinical course of Crohn’s disease strictures and help make treatment decisions relating to surgery, Victorian researchers have shown.

In a presentation at ECCO 2019, Dr Julien Schulberg and colleagues at the Department of Gastroenterology, St Vincent’s Hospital, Melbourne, described how they used MRE to characterise the natural history of Crohn’s disease strictures.

In a study involving 136 patients with 235 strictures, they analysed MRE scans at the time of diagnosis and compared the features found with the subsequent need for surgey over four years of follow up.

They found that 46% of patients required surgery, which was done after a median of six months. Clinical predictors of surgery included prior resection (lower risk, Odds Ratio 0.42) and a CRP over 10mg/L (OR 2.72).

New drug therapy with anti-TNF agents (within three months of stricture diagnosis) was associated with avoidance of surgery (OR 0.23).

MRE characteristics on multivariate analysis associated with surgery were proximal bowel dilatation >30mm diameter (Odds Ratio 2.98), bowel wall thickness at stricture (OR 2.42)  and stricture length (OR 2.56).

When these were combined, a MRE stricture risk score could be derived and the three point score strongly predicted the progression to surgery.  Overall, 81% of patients with these three features required surgery, compared to only 17% of patients where none were present.

“The prediction of surgery based on simple MRE characteristics (bowel wall thickness, stricture length and pre-stenotic dilatation) has great potential clinical value,” they concluded.

Anti-TNF therapy is associated with a reduced risk of surgery if commenced at stricture diagnosis and MRE may help identify patients who would benefit from treatment intensification,” they added.