Benefit of computed tomography enterography in Crohn's disease: Effects on patient management and physician level of confidence

David H. Bruining, Hassan A. Siddiki, Joel Garland Fletcher, William J. Sandborn, Jeff L. Fidler, James E. Huprich, Jayawant Mandrekar, William S. Harmsen, Paul E. Evans, William Alvis Faubion, Karen A. Hanson, Steven B. Ingle, Darrell S. Pardi, Kenneth W. Schroeder, William J. Tremaine, Edward Vincent Loftus, Jr

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms.

Original languageEnglish (US)
Pages (from-to)219-225
Number of pages7
JournalInflammatory Bowel Diseases
Volume18
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Crohn Disease
Tomography
Physicians
Inflammation
Disease Management
Abscess
Fistula
Patient Care
Sensitivity and Specificity

Keywords

  • Crohn's disease
  • CT enterography (CTE)
  • level of confidence
  • management plan

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Benefit of computed tomography enterography in Crohn's disease : Effects on patient management and physician level of confidence. / Bruining, David H.; Siddiki, Hassan A.; Fletcher, Joel Garland; Sandborn, William J.; Fidler, Jeff L.; Huprich, James E.; Mandrekar, Jayawant; Harmsen, William S.; Evans, Paul E.; Faubion, William Alvis; Hanson, Karen A.; Ingle, Steven B.; Pardi, Darrell S.; Schroeder, Kenneth W.; Tremaine, William J.; Loftus, Jr, Edward Vincent.

In: Inflammatory Bowel Diseases, Vol. 18, No. 2, 02.2012, p. 219-225.

Research output: Contribution to journalArticle

Bruining, DH, Siddiki, HA, Fletcher, JG, Sandborn, WJ, Fidler, JL, Huprich, JE, Mandrekar, J, Harmsen, WS, Evans, PE, Faubion, WA, Hanson, KA, Ingle, SB, Pardi, DS, Schroeder, KW, Tremaine, WJ & Loftus, Jr, EV 2012, 'Benefit of computed tomography enterography in Crohn's disease: Effects on patient management and physician level of confidence', Inflammatory Bowel Diseases, vol. 18, no. 2, pp. 219-225. https://doi.org/10.1002/ibd.21683
Bruining, David H. ; Siddiki, Hassan A. ; Fletcher, Joel Garland ; Sandborn, William J. ; Fidler, Jeff L. ; Huprich, James E. ; Mandrekar, Jayawant ; Harmsen, William S. ; Evans, Paul E. ; Faubion, William Alvis ; Hanson, Karen A. ; Ingle, Steven B. ; Pardi, Darrell S. ; Schroeder, Kenneth W. ; Tremaine, William J. ; Loftus, Jr, Edward Vincent. / Benefit of computed tomography enterography in Crohn's disease : Effects on patient management and physician level of confidence. In: Inflammatory Bowel Diseases. 2012 ; Vol. 18, No. 2. pp. 219-225.
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abstract = "Background: Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51{\%}). CTE changed management in 70 (48{\%}) of those with established disease, prompting medication changes in 35 (24{\%}). Management changes were made post-CTE in 69 (54{\%}) of those with suspected CD, predominantly due to excluding CD (36{\%}). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78{\%}). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms.",
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AU - Sandborn, William J.

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AU - Huprich, James E.

AU - Mandrekar, Jayawant

AU - Harmsen, William S.

AU - Evans, Paul E.

AU - Faubion, William Alvis

AU - Hanson, Karen A.

AU - Ingle, Steven B.

AU - Pardi, Darrell S.

AU - Schroeder, Kenneth W.

AU - Tremaine, William J.

AU - Loftus, Jr, Edward Vincent

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N2 - Background: Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms.

AB - Background: Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms.

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