Radiological Response Is Associated with Better Outcomes and Should Be Considered a Therapeutic Target in Crohn’s Disease

Background The aim of the study was to identify factors associated with a radiological response and to assess the impact of radiological improvement in long-term outcomes in small bowel (SB) Crohn’s disease (CD) patients. Methods We performed a retrospective study from June 2011 to June 2017 in the tertiary center, Claude Huriez Hospital in Lille, France. All SB CD patients, who underwent two magnetic resonance enterographies (MRE) 3–12 months apart, with at least 1-year follow-up after the second MRE, were included. Signs of radiological inflammation were identified by two expert radiologists in CD. Patients were classified as radiological responders (RR) and non-responders (NR). Hospitalization rates, adjustment of treatment, and surgical or endoscopic interventions were assessed and compared between RR and NR. Factors associated with a radiological response were also studied using the Cox model. Results One hundred and fifteen SB CD patients were included with a median follow-up of 17 months (IQR 11.6–28.3). There were 54 (47%) RR and 61 (53%) NR. The risk of surgical or endoscopic intervention was higher in NR than RR ( p = 0.04), and the median delay until a surgical or endoscopic intervention was shorter in NR ( p = 0.04). Multifocal disease, a hypersignal on diffusion-weighted or dynamic contrast-enhanced imaging, a stricture, or a fistula was significantly associated with a decreased probability of a radiological response ( p < 0.05). Conclusion This study shows that a radiological response is associated with a decreased risk of surgical or endoscopic intervention and should be considered as a therapeutic target in CD patients.