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Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 204–212 | Cite as

Creeping Fat Assessed by Small Bowel MRI Is Linked to Bowel Damage and Abdominal Surgery in Crohn’s Disease

  • Patrick Althoff
  • Wolff Schmiegel
  • Gernot Lang
  • Volkmar Nicolas
  • Thorsten BrechmannEmail author
Original Article
  • 149 Downloads

Abstract

Background

Crohn’s disease (CD) leads to bowel damage and surgery in a significant proportion of patients.

Aims

The aim of the study was to evaluate the predictive value of creeping fat assessed by small bowel MRI in CD patients.

Methods

CD patients undergoing small bowel MRI were included in a retrospective observational cohort study. Clinical findings were extracted and correlated with radiological outcome measures. Logistic regression analysis was performed to assess predictors associated with a complicated course and surgery within 2 years and long-term follow-up.

Results

Ninety patients (49% female, median follow-up 93 months) were included. Creeping fat was identified in 21.1%. Of these patients, 68% and 79% developed bowel damage (p < .05) and 42% and 63% of patients revealing creeping fat underwent surgery within 2 years following MRI and total follow-up, respectively. The presence of creeping fat [odds ratio (OR) 4.0], inflammatory stenosis (OR 3.7), multisegmental (small) bowel (OR 4.5 and 3.8), and proximal small bowel inflammation (OR 5.0) were associated with inferior outcome (p < .05) in a univariate analysis. Creeping fat was independently associated with a disabling course, bowel damage, and surgery (OR 3.5 each, p < .05) in a multivariate analysis model.

Conclusion

Creeping fat identified by small bowel MRI is associated with a complicated course and abdominal surgery in CD. Our data adds evidence that small bowel MRI facilitates risk stratification in order to define a patient at risk of disease-related complications in CD. [DRKS00011727, www.germanctr.de/].

Keywords

Bowel damage Small bowel MRI Prediction of outcome Creeping fat 

Notes

Acknowledgments

We gratefully thank Marlies Kersting-Schwarz for the assistance regarding the collection of MRI studies, Michaela Meyburg for her help throughout the study and, last, but not least, Igors Iesalnieks for discussing the data and reviewing the manuscript.

Author’s contribution

PA conducted the study, acquired the data, performed analysis and interpretation, and drafted the manuscript. Prof. Dr. WS supervised the study, revised the manuscript, and provided support in terms of gastroenterology. Prof. Dr. VN supervised the study, revised the manuscript, and provided support in terms of small bowel MRI. Dr. GL acquired the data and revised the manuscript. Dr. TB conceived and designed the study, analyzed and interpreted the data, supervised the study, and drafted the manuscript. All authors approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no actual or potential conflict of interest.

Supplementary material

10620_2018_5303_MOESM1_ESM.pdf (363 kb)
Supplementary material 1 (PDF 363 kb)

References

  1. 1.
    Peyrin-Biroulet L, Loftus EV, Colombel JF, et al. The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol. 2009;105:289–297.CrossRefGoogle Scholar
  2. 2.
    Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380:1590–1605.CrossRefGoogle Scholar
  3. 3.
    Ordás I, Feagan BG, Sandborn WJ. Early use of immunosuppressives or TNF antagonists for the treatment of Crohn’s disease: time for a change. Gut. 2011;60:1754–1763.CrossRefGoogle Scholar
  4. 4.
    Peyrin-Biroulet L, Oussalah A, Williet N, et al. Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn’s disease. Gut. 2011;60:930–936.CrossRefGoogle Scholar
  5. 5.
    Safroneeva E, Vavricka SR, Fournier N, et al. Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn’s disease. Aliment Pharmacol Ther. 2015;42:977–989.CrossRefGoogle Scholar
  6. 6.
    Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, et al. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). Am J Gastroenterol. 2012;107:1693–1701.CrossRefGoogle Scholar
  7. 7.
    Rogler G, Bernstein CN, Sood A, et al. Role of biological therapy for inflammatory bowel disease in developing countries. Gut. 2012;61:706–712.CrossRefGoogle Scholar
  8. 8.
    Antunes O, Filippi J, Hébuterne X, et al. Treatment algorithms in Crohn’s—up, down or something else? Best Pract Res Clin Gastroenterol. 2014;28:473–483.CrossRefGoogle Scholar
  9. 9.
    Singh S, Loftus EV. Crohn’s disease: REACT to save the gut. Lancet. 2015;386:1800–1802.CrossRefGoogle Scholar
  10. 10.
    Zallot C, Peyrin-Biroulet L. Clinical risk factors for complicated disease: how reliable are they? Dig Dis. 2012;30:67–72.CrossRefGoogle Scholar
  11. 11.
    Torres J, Caprioli F, Katsanos KH, et al. Predicting outcomes to optimize disease management in inflammatory bowel diseases. J Crohns Colitis. 2016;10:1385–1394.CrossRefGoogle Scholar
  12. 12.
    Thia KT, Sandborn WJ, Harmsen WS, et al. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010;139:1147–1155.CrossRefGoogle Scholar
  13. 13.
    Aldhous MC, Drummond HE, Anderson N, et al. Does cigarette smoking influence the phenotype of Crohn’s disease? Analysis using the Montreal classification. Am J Gastroenterol. 2007;102:577–588.CrossRefGoogle Scholar
  14. 14.
    Kredel LI, Batra A, Stroh T, et al. Adipokines from local fat cells shape the macrophage compartment of the creeping fat in Crohn’s disease. Gut. 2013;62:852–862.CrossRefGoogle Scholar
  15. 15.
    Schäffler A, Herfarth H. Creeping fat in Crohn’s disease: travelling in a creeper lane of research? Gut. 2005;54:742–744.CrossRefGoogle Scholar
  16. 16.
    Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis; a pathologic and clinical entity. Am J Med. 1952;13:583–590.CrossRefGoogle Scholar
  17. 17.
    Sheehan AL, Warren BF, Gear MW, et al. Fat-wrapping in Crohn’s disease: pathological basis and relevance to surgical practice. Br J Surg. 1992;79:955–958.CrossRefGoogle Scholar
  18. 18.
    Golder WA. The “creeping fat sign”—really diagnostic for Crohn’s disease? Int J Colorectal Dis. 2009;24:1–4.CrossRefGoogle Scholar
  19. 19.
    Borley NR, Mortensen NJ, Jewell DP, et al. The relationship between inflammatory and serosal connective tissue changes in ileal Crohn’s disease: evidence for a possible causative link. J Pathol. 2000;190:196–202.CrossRefGoogle Scholar
  20. 20.
    Spinelli A, Fiorino G, Bazzi P, et al. Preoperative magnetic resonance enterography in predicting findings and optimizing surgical approach in Crohn’s disease. J Gastrointest Surg. 2014;18:8390–8391. (discussion).CrossRefGoogle Scholar
  21. 21.
    Panes J, Bouzas R, Chaparro M, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther. 2011;34:125–145.CrossRefGoogle Scholar
  22. 22.
    Rimola J, Ordas I, Rodriguez S, et al. Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis. 2011;17:1759–1768.CrossRefGoogle Scholar
  23. 23.
    Lang G, Schmiegel W, Nicolas V, et al. Impact of small bowel MRI in routine clinical practice on staging of Crohn’s disease. J Crohns Colitis. 2015;9:784–794.CrossRefGoogle Scholar
  24. 24.
    García-Bosch O, Ordás I, Aceituno M, et al. Comparison of diagnostic accuracy and impact of magnetic resonance imaging and colonoscopy for the management of Crohn’s disease. J Crohns Colitis. 2016;10:663–669.CrossRefGoogle Scholar
  25. 25.
    Rimola J, Planell N, Rodríguez S, et al. Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol. 2015;110:432–440.CrossRefGoogle Scholar
  26. 26.
    Bouhnik Y, Carbonnel F, Laharie D, et al. GETAID CREOLE Study Group. Efficacy of adalimumab in patients with Crohn’s disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut. 2018;67:53–60.CrossRefGoogle Scholar
  27. 27.
    Jauregui-Amezaga A, Rimola J, Ordás I, et al. Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn’s disease in the era of biologics. Gut. 2015;64:1397–1402.CrossRefGoogle Scholar
  28. 28.
    Fiorino G, Morin M, Bonovas S, et al. Prevalence of bowel damage assessed by cross-sectional imaging in early Crohn’s disease and its impact on disease outcome. J Crohns Colitis. 2017;11:274–280.CrossRefGoogle Scholar
  29. 29.
    Pauls S, Kratzer W, Rieber A, et al. Quantifying the inflammatory activity in Crohn’s disease using CE dynamic MRI. Rofo. 2003;175:1093–1099.CrossRefGoogle Scholar
  30. 30.
    Amitai MM, Raviv-Zilka L, Hertz M, et al. Main imaging features of Crohn’s disease: agreement between MR-enterography and CT-enterography. Isr Med Assoc J. 2015;17:293–297.PubMedGoogle Scholar
  31. 31.
    Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis. 2011;17:1073–1080.CrossRefGoogle Scholar
  32. 32.
    Danese S, Fiorino G, Peyrin-Biroulet L. Early intervention in Crohn’s disease: towards disease modification trials. Gut. 2017;66:2179–2187.CrossRefGoogle Scholar
  33. 33.
    Dias CC, Rodrigues PP, Coelho R, et al. Development and validation of risk matrices for Crohn’s disease outcomes in patients who underwent early therapeutic interventions. J Crohns Colitis. 2017;11:445–453.CrossRefGoogle Scholar
  34. 34.
    Koh DM, Miao Y, Chinn RJ, et al. MR imaging evaluation of the activity of Crohn’s disease. AJR Am J Roentgenol. 2001;177:1325–1332.CrossRefGoogle Scholar
  35. 35.
    Peyrin-Biroulet L, Billioud V, D’Haens G, et al. Development of the Paris definition of early Crohn’s disease for disease-modification trials: results of an international expert opinion process. Am J Gastroenterol. 2012;107:1770–1776.CrossRefGoogle Scholar
  36. 36.
    Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5–36.CrossRefGoogle Scholar
  37. 37.
    Drouet M, Dubuquoy L, Desreumaux P, et al. Visceral fat and gut inflammation. Nutrition. 2012;28:113–117.CrossRefGoogle Scholar
  38. 38.
    Cosnes J, Cattan S, Blain A, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8:244–250.CrossRefGoogle Scholar
  39. 39.
    Rimola J, Rodriguez S, Garcia-Bosch O, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut. 2009;58:1113–1120.CrossRefGoogle Scholar
  40. 40.
    Rimola J, Ordas I, Rodriguez S, et al. Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis. 2011;17:1759–1768.CrossRefGoogle Scholar
  41. 41.
    Baraniskin A, Van Laethem JL, Wyrwicz L, et al. Clinical relevance of molecular diagnostics in gastrointestinal (GI) cancer: European Society of Digestive Oncology (ESDO) expert discussion and recommendations from the 17th European Society for Medical Oncology (ESMO)/World Congress on Gastrointestinal Cancer, Barcelona. Eur J Cancer. 2017;86:305–317.CrossRefGoogle Scholar
  42. 42.
    Deepak P, Fletcher JG, Fidler JL, et al. Radiological response is associated with better long-term outcomes and is a potential treatment target in patients with small bowel Crohn’s disease. Am J Gastroenterol. 2016;111:997–1006.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyBerufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University BochumBochumGermany
  2. 2.Department of MedicineUniversitätsklinikum Knappschaftskrankenhaus Bochum GmbHBochumGermany
  3. 3.Department of Orthopedic and Trauma SurgeryUniversity Medical Center FreiburgFreiburgGermany
  4. 4.Diagnostic and Interventional RadiologyBerufsgenossenschaftliche Universitätsklinik Bergmannsheil Bochum gGmbHBochumGermany

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