Measurement of Fibrosis in Crohn's Disease Strictures with Imaging and Blood Biomarkers to Inform Clinical Decisions

Abstract

Background: Distinguishing fibrosis from inflammation in an intestinal stricture in Crohn's disease is quite difficult. The absence of signs of inflammation on CT or MRI does not prove the absence of inflammation, as most strictures have a mix of fibrosis and inflammation. Identifying refractory fibrosis and distinguishing the patients who will respond to anti-inflammatory therapy from those who will require surgery are important clinical requirements, and several new technologies in imaging and serum biomarkers are being applied to this problem. Key Messages: Delayed gadolinium enhancement of a Crohn's disease stricture on MRI can reliably identify severe fibrosis, and may be helpful in deciding which patients will require surgery. However, this approach does not appear to be able to identify patients with mild or moderate fibrosis. New imaging technologies, including T2/magnetization transfer MRI, shear wave velocity ultrasound, and photoacoustic imaging, offer promising animal data that could prove to accurately assist clinical decision making. Glyoproteomics has identified hepatic growth factor alpha and cartilage oligomeric matrix protein as possible serum biomarkers to detect and measure intestinal fibrosis. The presence of upstream small bowel dilation >3.5 cm or a platelet/albumin ratio >150 helps in identifying Crohn's disease patients at high risk of stricture resection in the next 2 years. Conclusions: Imaging and biomarker technologies to measure intestinal fibrosis are rapidly evolving, and could soon provide valuable information for clinical decision making for patients with intestinal strictures from Crohn's disease