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E1211. Small Bowel Treatment Review of the Lifelong Journey Called Crohn’s
Authors
  1. Wyanne Law; University of Toronto
  2. Luis Guimaraes; University of Toronto
  3. Samir Grover; University of Toronto
  4. Cindy Law; University of Toronto
  5. Monica Tafur; University of Toronto
Background
Crohn’s disease is a lifelong disease that affects 0.3% of the population in western countries. Historically, Crohn’s disease was treated using a step-up approach until symptoms resolved. The present treat-to-target approach aims to resolve underlying inflammation as indicated by biomarkers to achieve long term remission. As endoscopy can only reach the terminal ileum and examine the mucosal surface, cross-sectional imaging, Computed Tomography enterography or Magnetic Resonance enterography (CTE / MRE), is helpful to evaluate the full extent of transmural disease, treatment response and to assess for complications.

Educational Goals / Teaching Points
The educational goals are to systematically illustrate response or failure to medical treatment of small bowel Crohn’s disease of varying severity over time. We will discuss implications of imaging findings on medical and surgical treatment for Crohn’s disease.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
There are many clinical, endoscopic and imaging scores that indicate inflammatory activity and severity of Crohn’s disease. Most commonly used imaging scores are Magnetic Index of Activity (MaRIA) and Crohn Disease Activity Score (CDAS). These scores are based on active mucosal inflammation, such as mural enhancement, wall thickening, intramural edema and ulceration. Additional signs of mesenteric inflammation can be helpful, such as perienteric edema, engorged vasa recta (Comb sign), fibrofatty proliferation, mesenteric venous thrombosis and adenopathy. Patients are started on medical treatment, usually glucocorticoids, in addition to biologics, such as anti-tumour necrosis factor alpha (anti-TNF), immunomodulators, anti-leukin 12/23 antibody, etc. Some patients will respond to medical therapy. Others will progress to strictures and penetrating disease including fistula, inflammatory mass and abscess. Those who fail medical therapy will proceed with surgical/ interventional therapy, including small bowel resection, abscess drainage and stricturoplasty. Wide variety of extra-intestinal manifestations of Crohn’s disease will be briefly discussed.

Conclusion
Management of Crohn's disease depends on the severity of disease and response to different types of treatment. Imaging can be helpful assessing for response to treatment and complications, which complements biomarkers and endoscopy.