Magnetic resonance enteroscopy (MRE) and capsule endoscopy (CE) are effective in evaluating Crohn's disease and managing inflammatory bowel disease (IBD) while avoiding ionizing radiation, according to several studies presented at the American College of Gastroenterology's (ACG) 75th Annual Scientific meeting.
One retrospective study presented at the ACG conference, held in San Antonio, found that patients with IBD at a Houston-area hospital were exposed to large amounts of radiation, including an average of 1.5 times the dose received by patients with ulcerative colitis. The study also discovered that 21 percent of males under the age of 35 in the 287-patient sample had been exposed to more than 75 mSv of radiation.
These doses were higher than the scores of females with the same diagnoses and substantially above the average doses for full-body CT, which releases two to 16 mSv. The study was performed by Jason Hou, MD, Baylor College of Medicine in Houston, and colleagues.
Two studies were presented on the utilization of MRE to evaluate Crohn's disease. "Assessing Crohn's disease activity in the small bowel is challenging as direct visualization is difficult and traditional radiographic studies can result in large cumulative radiation [exposure]," explained Siobhan Byrne, MD, and Helen Fasanya-Uptagraft, MD, of the University of Wisconsin in Madison.
Byrne and Fasanya-Uptagraft's findings revealed that the majority of severe cases of Crohn's had higher MRE scores, while 75 percent of clinically severe cases revealed definite MRE disease activity. In mild to moderate cases, though, MRE was unlikely to show disease activity.
Another study completed by Samir A. Shah, MD, and Adam Harris, MD, of Brown University in Providence, R.I., observed that MRE sensitivity and specificity in measuring Crohn's disease reached 84 and 76 percent, respectively, of the sensitivity and specificity of endoscopy. "MRE highly correlates with endoscopic and histological assessment for the evaluation of known or suspected Crohn's disease non-invasively and without the exposure to ionizing radiation of CT enterography," Shah concluded.
Finally, a study of patients diagnosed with Crohn's disease who were undergoing capsule endoscopy showed that 61 percent saw changes in their IBD medication within three months of the exam and 13 percent underwent surgery. For patients in whom capsule endoscopy showed evidence of severe IBD, even larger modifications in treatment were observed. "We found that capsule endoscopy resulted in management changes in the majority of cases, regardless of the findings or the subtype of IBD," concluded Millie Long, MD, of University of North Carolina in Durham.