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Article ; Online: Contemporary Imaging Assessment of Strictures and Fibrosis in Crohn Disease, With Focus on Quantitative Biomarkers: From the

Rimola, Jordi / Beek, Kim J / Ordás, Ingrid / Gecse, Krisztina B / Cuatrecasas, Míriam / Stoker, Jaap

2023 Volume 222, Issue 4, Page(s) e2329693

Abstract: Patients with Crohn disease commonly have bowel strictures develop, which exhibit varying degrees of inflammation and fibrosis. Differentiation of the distinct inflammatory and fibrotic components of strictures is key for the optimization of therapeutic ... ...

Abstract	Patients with Crohn disease commonly have bowel strictures develop, which exhibit varying degrees of inflammation and fibrosis. Differentiation of the distinct inflammatory and fibrotic components of strictures is key for the optimization of therapeutic management and for the development of antifibrotic drugs. Cross-sectional imaging techniques, including ultrasound, CT, and MRI, allow evaluation of the full thickness of the bowel wall as well as extramural complications and associated mesenteric abnormalities. Although promising data have been reported for a range of novel imaging biomarkers for detection of fibrosis and quantification of the degree of fibrosis, these biomarkers lack sufficient validation and standardization for clinical use. Additional methods, including PET with emerging radiotracers, artificial intelligence, and radiomics, are also under investigation for stricture characterization. In this review, we highlight the clinical relevance of identifying fibrosis in Crohn disease, review the histopathologic aspects of strictures in Crohn disease, summarize the morphologic imaging findings of strictures, and explore contemporary developments in the use of cross-sectional imaging techniques for detecting and characterizing intestinal strictures, with attention given to emerging quantitative biomarkers.
MeSH term(s)	Humans ; Crohn Disease/diagnostic imaging ; Crohn Disease/complications ; Fibrosis/diagnostic imaging ; Constriction, Pathologic/diagnostic imaging ; Biomarkers/metabolism ; Diagnostic Imaging/methods
Chemical Substances	Biomarkers
Language	English
Publishing date	2023-08-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	82076-3
ISSN	1546-3141 ; 0361-803X ; 0092-5381
ISSN (online)	1546-3141
ISSN	0361-803X ; 0092-5381
DOI	10.2214/AJR.23.29693
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Article ; Online: Letter: accuracy of magnetic resonance index of activity score to predict response to biologics in Crohn's disease-authors' reply.

Rimola, Jordi / Panés, Julian / Ordás, Ingrid

Alimentary pharmacology & therapeutics

2020 Volume 53, Issue 1, Page(s) 207–208

MeSH term(s)	Biological Products/therapeutic use ; Crohn Disease/diagnostic imaging ; Crohn Disease/drug therapy ; Humans ; Magnetic Resonance Spectroscopy ; Tumor Necrosis Factor Inhibitors ; Tumor Necrosis Factor-alpha
Chemical Substances	Biological Products ; Tumor Necrosis Factor Inhibitors ; Tumor Necrosis Factor-alpha
Language	English
Publishing date	2020-12-14
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.16163
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Article ; Online: Magnetic resonance enterography findings 46 weeks after initiation of biological therapy predict long-term adverse outcomes in Crohn's disease.

Fernández-Clotet, Agnès / Ordás, Ingrid / Masamunt, Maria Carme / Caballol, Berta / Rodríguez, Sonia / Gallego, Marta / Barastegui, Rebeca / Saavedra, Anny Carolina / Panés, Julián / Ricart, Elena / Rimola, Jordi

Alimentary pharmacology & therapeutics

2024 Volume 59, Issue 11, Page(s) 1435–1445

Abstract: Background and aims: Magnetic resonance enterography (MRE) depicts transmural changes in response to biological treatment for Crohn's disease (CD); however, the long-term prognostic significance of these findings is unknown. The primary objective of ... ...

Abstract	Background and aims: Magnetic resonance enterography (MRE) depicts transmural changes in response to biological treatment for Crohn's disease (CD); however, the long-term prognostic significance of these findings is unknown. The primary objective of this study was to identify findings on MRE 46 weeks after initiating biological treatment that predict adverse long-term outcomes. Methods: Patients with CD underwent MRE 46 weeks after initiating biological treatment and were prospectively followed for 2 years. A logistic regression analysis was performed to assess the prognostic value of different radiologic findings for various predefined adverse outcomes. Results: Of the 89 patients included, 46 (51.7%) had ≥1 adverse outcome during follow-up: 40 (44.9%) had clinical recurrence; 18 (20.2%) required surgery, 8 (9%) endoscopic balloon dilation, 12 (13.5%) hospitalization and 7 (7.8%) required corticosteroids. In the multivariate analysis, persistence of severe lesions (MaRIA ≥11) in any intestinal segment was associated with an increased risk of surgery [OR 11.6 (1.5-92.4)], of surgery and/or endoscopic balloon dilation [OR 6.3 (1.3-30.2)], and of clinical relapse [OR 4.6 (1.6-13.9)]. Penetrating lesions were associated with surgery [OR 3.4 (1.2-9.9)]. Creeping fat with hospitalization [OR 5.1 (1.1-25.0)] and corticosteroids requirement [OR 16.0 (1.2-210.0)]. The presence of complications (stricturing and/or penetrating lesions) was associated with having ≥1 adverse outcome [OR 3.35 (1.3-8.5)]. Conclusion: MRE findings at week-46 after initiating biological therapy can predict long-term adverse outcomes in CD. Therapeutic intervention may be required in patients with persistence of severe inflammatory lesions, CD-associated complications, or creeping fat.
MeSH term(s)	Humans ; Crohn Disease/diagnostic imaging ; Crohn Disease/drug therapy ; Female ; Male ; Adult ; Magnetic Resonance Imaging/methods ; Prospective Studies ; Middle Aged ; Prognosis ; Treatment Outcome ; Young Adult ; Recurrence ; Biological Therapy/adverse effects ; Biological Therapy/methods ; Follow-Up Studies
Language	English
Publishing date	2024-04-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.17968
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Article ; Online: MRI features indicative of permanent colon damage in ulcerative colitis: an exploratory study.

Rimola, Jordi / Castro-Poceiro, Jesús / Sapena, Víctor / Aduna, Marta / Arevalo, Juan / Vera, Isabel / Pastrana, Miguel Ángel / Gallego, Marta / Masamunt, Maria Carme / Fernández-Clotet, Agnès / Ordás, Ingrid / Ricart, Elena / Panés, Julian

Journal of Crohn's & colitis

2024

Abstract: Background and aims: It is uncertain whether ulcerative colitis leads to accumulated bowel damage on cross sectional image. We aimed to characterize bowel damage in patients with ulcerative colitis using magnetic resonance imaging and determine its ... ...

Abstract	Background and aims: It is uncertain whether ulcerative colitis leads to accumulated bowel damage on cross sectional image. We aimed to characterize bowel damage in patients with ulcerative colitis using magnetic resonance imaging and determine its relation with duration of disease and the impact on patients' quality of life. Methods: In this prospective study, subjects with ulcerative colitis in endoscopic remission underwent MRI without bowel cleansing and completed quality-of-life questionnaires. Subjects' magnetic resonance findings were analyzed considering normal values and thresholds determined in controls with no history of inflammatory bowel disease (n=40) and in patients with Crohn's disease with no history of colonic involvement (n=12). Subjects with UC were stratified according to disease duration (<7 years vs. 7‒14 years vs. >14 years). Results: We analyzed 41 subjects with ulcerative colitis [20 women; Mayo endoscopic subscore 0 in 38 (92.7%) and 1 in 3 (7.3%)]. Paired segment-by-segment comparison of magnetic resonance findings in colonic segments documented of being affected by ulcerative colitis versus controls showed subjects with ulcerative colitis had decreased cross-sectional area (p≤0.0034) and perimeter (p≤0.0005), and increased wall thickness (p=0.026) in all segments. Colon damage, defined as wall thickness ≥3 mm, was seen in 22 (53.7%) subjects. Colon damage was not associated with disease duration or quality of life. Conclusions: Morphologic abnormalities in the colon were highly prevalent in patients with ulcerative colitis in the absence of inflammation. Structural bowel damage was not associated with disease duration or quality of life.
Language	English
Publishing date	2024-05-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjae075
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Article ; Online: Successful management of refractory immune-mediated enterocolitis with cyclosporine.

Pesántez, David / Seguí, Elia / Ordás, Ingrid / Viladot, Marga / Arance, Ana

European journal of cancer (Oxford, England : 1990)

2020 Volume 131, Page(s) 37–39

MeSH term(s)	Adult ; Antineoplastic Agents, Immunological/adverse effects ; Biopsy ; Colon/diagnostic imaging ; Colon/drug effects ; Colon/immunology ; Colon/pathology ; Colonoscopy ; Cyclosporine/therapeutic use ; Drug Resistance ; Enterocolitis/chemically induced ; Enterocolitis/diagnosis ; Enterocolitis/drug therapy ; Enterocolitis/immunology ; Female ; Gastrointestinal Agents/pharmacology ; Gastrointestinal Agents/therapeutic use ; Humans ; Immunosuppressive Agents/therapeutic use ; Infliximab/pharmacology ; Infliximab/therapeutic use ; Melanoma/drug therapy ; Melanoma/immunology ; Methylprednisolone/pharmacology ; Methylprednisolone/therapeutic use ; Programmed Cell Death 1 Receptor/antagonists & inhibitors ; Programmed Cell Death 1 Receptor/immunology ; Skin Neoplasms/drug therapy ; Skin Neoplasms/immunology ; Treatment Outcome
Chemical Substances	Antineoplastic Agents, Immunological ; Gastrointestinal Agents ; Immunosuppressive Agents ; PDCD1 protein, human ; Programmed Cell Death 1 Receptor ; Cyclosporine (83HN0GTJ6D) ; Infliximab (B72HH48FLU) ; Methylprednisolone (X4W7ZR7023)
Language	English
Publishing date	2020-04-08
Publishing country	England
Document type	Case Reports ; Letter
ZDB-ID	82061-1
ISSN	1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
ISSN (online)	1879-0852
ISSN	0277-5379 ; 0959-8049 ; 0964-1947
DOI	10.1016/j.ejca.2020.02.014
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Article ; Online: Avoiding contrast-enhanced sequences does not compromise the precision of the simplified MaRIA for the assessment of non-penetrating Crohn's disease activity.

Fernàndez-Clotet, Agnès / Sapena, Víctor / Capozzi, Nunzia / Rodríguez, Sonia / Masamunt, Maria-Carme / Ricart, Elena / Ordás, Ingrid / Panés, Julian / Rimola, Jordi

European radiology

2022 Volume 32, Issue 5, Page(s) 3334–3345

Abstract: Objectives: Patients with Crohn's disease (CD) require multiple assessments with magnetic resonance enterography (MRE) from a young age. Standard MRE protocols for CD include contrast-enhanced sequences. Gadolinium deposits in brain tissue suggest ... ...

Abstract	Objectives: Patients with Crohn's disease (CD) require multiple assessments with magnetic resonance enterography (MRE) from a young age. Standard MRE protocols for CD include contrast-enhanced sequences. Gadolinium deposits in brain tissue suggest avoiding gadolinium could benefit patients with CD. This study aimed to compare the accuracy of the simplified Magnetic Resonance Index of Activity (sMaRIA) calculated with and without contrast-enhanced sequences in determining the response to biologic drugs in patients with CD. Methods: This post hoc analysis of a prospective study included patients with CD with endoscopic ulceration in ≥ 1 intestinal segment starting biologic drug therapy. Two blinded radiologists used the sMaRIA to score images obtained at baseline and week 46 of treatment first using only unenhanced sequences (T2-sMaRIA) and 1 month later using both unenhanced and enhanced images (CE-sMaRIA). We calculated the rates of agreement between T2-sMaRIA, CE-sMaRIA, and ileocolonoscopy for different conceptualizations of therapeutic response. Results: A total of 46 patients (median age, 36 years [IQR: 28-47]) were included. Agreement with ileocolonoscopy was similar for CE-sMaRIA and T2-sMaRIA in identifying ulcer healing (kappa = 0.74 [0.55-0.93] and 0.70 [0.5-0.9], respectively), treatment response (kappa = 0.53 [0.28-0.79] and 0.44 [0.17 - 0.71]), and remission (kappa = 0.48 [0.22-0.73] and 0.43 [0.17-0.69]). The standardized effect size was moderate for both CE-sMaRIA = 0.63 [0.41-0.85] p < 0.001 and T2-sMaRIA = 0.58 [0.36-0.80] p < 0.001. Conclusions: sMaRIA with and without contrast-enhanced images accurately classified the response according to different therapeutic endpoints determined by ileocolonoscopy. Key points: • The simplified Magnetic Resonance Index of Activity is accurate for the assessment of Crohn's disease activity, severity, and therapeutic response, using four dichotomic components that can be evaluated without the need of using contrast-enhanced sequences, representing a practical and safety advantage, but concerns have been expressed as to whether the lack of contrast sequences may compromise precision. • The simplified Magnetic Resonance Index of Activity can assess the response to biologic therapy in patients with Crohn's disease without the need for intravenous contrast agents obtaining comparable results without and with contrast-enhanced sequences. • Avoiding intravenous contrast agents could reduce the duration of the MRE examination and its cost and would increase the acceptance and safety of MRE in clinical research in patients with Crohn's disease.
MeSH term(s)	Adult ; Contrast Media/pharmacology ; Crohn Disease/diagnosis ; Gadolinium/pharmacology ; Humans ; Magnetic Resonance Imaging/methods ; Prospective Studies
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2022-01-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-021-08392-w
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Article ; Online: ADC Values for Detecting Bowel Inflammation and Biologic Therapy Response in Patients With Crohn Disease: A Post Hoc Prospective Trial Analysis.

Rimola, Jordi / Fernandez-Clotet, Agnès / Capozzi, Nunzia / Caballol, Berta / Rodríguez, Sonia / Gallego, Marta / Masamunt, Maria Carme / Panés, Julian / Ricart, Elena / Ordás, Ingrid

AJR. American journal of roentgenology

2023 Volume 222, Issue 1, Page(s) e2329639

Abstract: BACKGROUND. ...

Abstract	BACKGROUND.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Biological Therapy ; Crohn Disease ; Diffusion Magnetic Resonance Imaging/methods ; Inflammation ; Magnetic Resonance Imaging ; Prospective Studies ; Ulcer ; Clinical Trials as Topic
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	82076-3
ISSN	1546-3141 ; 0361-803X ; 0092-5381
ISSN (online)	1546-3141
ISSN	0361-803X ; 0092-5381
DOI	10.2214/AJR.23.29639
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Article ; Online: MR colonography in inflammatory bowel disease.

Rimola, Jordi / Ordás, Ingrid

Magnetic resonance imaging clinics of North America

2014 Volume 22, Issue 1, Page(s) 23–33

Abstract: MR colonography has a high diagnostic accuracy for detecting Crohn disease (CD) activity and determining the extent and severity of lesions. In the setting of stricturing CD, MR colonography can provide a detailed map of the lesions, which is useful for ... ...

Abstract	MR colonography has a high diagnostic accuracy for detecting Crohn disease (CD) activity and determining the extent and severity of lesions. In the setting of stricturing CD, MR colonography can provide a detailed map of the lesions, which is useful for clinical decision making. MR colonography can be used as an alternative to conventional colonoscopy in the setting of CD, or as a complementary tool in selected patients with ulcerative colitis. This article reviews the spectrum of MR colonography findings in colonic inflammatory bowel disease and discusses the potential applications and limitations of MR colonography.
MeSH term(s)	Humans ; Image Enhancement/methods ; Inflammatory Bowel Diseases/pathology ; Intestines/pathology ; Magnetic Resonance Imaging/methods
Language	English
Publishing date	2014-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196851-5
ISSN	1557-9786 ; 1064-9689
ISSN (online)	1557-9786
ISSN	1064-9689
DOI	10.1016/j.mric.2013.07.011
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Article: De-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice.

Arenas, Alex / Moreta, María José / Ordás, Ingrid / Fernández-Clotet, Agnès / Caballol, Berta / Gallego, Marta / Vara, Alejandro / Barastegui, Rebeca / Giner, Angel / Prieto, Cristina / Masamunt, Maria Carme / Candia, Roberto / Ricart, Elena

Gastroenterologia y hepatologia

2023

Abstract: Background and objectives: Combination therapy with an immunomodulator (IMM) and an anti-TNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de- ... ...

Abstract	Background and objectives: Combination therapy with an immunomodulator (IMM) and an anti-TNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse. Methods: This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse. Results: The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p<0.001). Multivariate analysis showed that anti-TNF discontinuation (HR=3.01; 95% CI=1.22-7.43) and ileal CD location (HR=2.36; 95% CI=1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR=0.32; 95% CI=0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe. Conclusion: Anti-TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe.
Language	Spanish
Publishing date	2023-08-08
Publishing country	Spain
Document type	Journal Article
ZDB-ID	632502-6
ISSN	0210-5705
ISSN	0210-5705
DOI	10.1016/j.gastrohep.2023.07.005
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Article ; Online: Cyclophosphamide-free mobilisation increases safety while preserving the efficacy of autologous haematopoietic stem cell transplantation in refractory Crohn's disease patients.

Giordano, Antonio / Rovira, Montserrat / Veny, Marisol / Barastegui, Rebeca / Marín, Pedro / Martínez, Carmen / Fernández-Avilés, Francesc / Suárez-Lledó, María / Domènech, Ariadna / Serrahima, Anna / Lozano, Miquel / Cid, Joan / Ordás, Ingrid / Fernández-Clotet, Agnés / Caballol, Berta / Gallego, Marta / Vara, Alejandro / Masamunt, Maria Carme / Giner, Àngel /

Teubel, Iris / Esteller, Miriam / Corraliza, Anna María / Panés, Julian / Salas, Azucena / Ricart, Elena

Journal of Crohn's & colitis

2024

Abstract: Background and aim: Autologous haematopoietic stem cell transplantation [AHSCT] is a therapeutic option for refractory Crohn's disease [CD]. However, high adverse event rates related to chemotherapy toxicity and immunosuppression limit its applicability. ...

Abstract	Background and aim: Autologous haematopoietic stem cell transplantation [AHSCT] is a therapeutic option for refractory Crohn's disease [CD]. However, high adverse event rates related to chemotherapy toxicity and immunosuppression limit its applicability. This study aims to evaluate AHSCT's safety and efficacy using a cyclophosphamide (Cy)-free mobilisation regimen. Methods: A prospective observational study included 14 refractory CD patients undergoing AHSCT between June 2017 and October 2022. The protocol involved outpatient mobilisation with G-CSF 12-16 μg/kg/daily for 5 days, and optional Plerixafor 240 μg/d (1-2 doses) if the CD34+ cell count target was unmet. Standard conditioning with Cy and anti-thymocyte globulin was administered. Clinical, endoscopic, and radiological assessments were conducted at baseline and during follow-up. Results: All patients achieved successful outpatient mobilisation (7 patients needed Plerixafor) and underwent transplantation. Median follow-up was 106 weeks (IQR 52-348). No mobilisation-related serious adverse events (SAEs) or CD worsening occurred. Clinical and endoscopic remission rates were 71% and 41.7% at 26 weeks, 64% and 25% at 52 weeks, and 71% and 16.7% at the last follow-up. The percentage of patients who restarted CD therapy for clinical relapse and/or endoscopic/radiological activity was 14% at 26 weeks, 57% at 52 weeks, and 86% at the last follow-up. Peripheral blood cell populations and antibody levels post-AHSCT were comparable to Cy-based mobilisation. Conclusions: Cy-free mobilisation is safe and feasible in refractory CD patients undergoing AHSCT. Although relapse occurs in a significant proportion of patients, clinical and endoscopic responses are achieved upon CD-specific therapy reintroduction.
Language	English
Publishing date	2024-05-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjae076
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