It is difficult for clinicians to distinguish whether a patient with Crohn’s disease has intestinal fibrosis, which requires surgery, or inflammation, which can be treated with medicine. A new imaging method could make that task easier.

Ultrasound elasticity imaging (UEI), could allow clinicians to make the distinction between inflammation and fibrosis noninvasively, allowing patients to receive more appropriate and timely care. The study was published in the September 2011 edition of the journal Gastroenterology.

Crohn’s disease patients suffer from chronic inflammation of the intestines, which over time can cause scar tissue to form, resulting in intestinal fibrosis. Patients with intestinal inflammation usually are treated with medicines that suppress their immune system, while patients with fibrosis are treated surgically. Because current diagnostic tests, including computed tomography (CT) and magnetic resonance imaging (MRI) scans, cannot detect the difference between the two conditions, many patients with fibrosis are often initially treated with immune system-suppressing drugs, which are expensive and are unlikely to help.

“These therapies are potent, costly, and carry risk,” said Ryan Stidham, MD, clinical lecturer in the University of Michigan (U-M; Ann Arbor, USA) department of internal medicine. “And for patients with fibrosis, such treatment might be for naught.”

Inflamed intestinal tissue is softer than fibrotic tissue, which is hard and thick. The new method uses ultrasound to measure the relative hardness and thickness of tissue inside the body, potentially allowing clinicians to distinguish between the two conditions without performing surgery. In animal models, UEI was able to visualize accurately the difference between inflamed tissue and scar tissue. “The goal of this study is to have technology that can make the distinction between fibrosis and inflammation,” stated Dr. Stidham, the lead author of the study. “We want to know if it’s worth it to push medical therapy, or if a person is destined for surgery.”

Moreover, the researchers discovered that UEI was capable of differentiating between fibrotic and unaffected intestine in a pilot human study. Patients already scheduled for surgical treatment underwent UEI assessment prior to surgery, and fibrotic strictures were identified in each case.

According to Dr. Stidham, the next step in the group’s research is a long-term human clinical trial, beginning the end of 2011. If UEI is able to evaluate a patient’s condition effectively, physicians will be able to treat Crohn’s disease patients suffering from inflammation or fibrosis more efficiently. “UEI has great potential to provide a clear measurement that helps clinicians judge whether medical or surgical management is best for the individual patient earlier in their disease course,” Dr. Stidham concluded.

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