Scientific Abstract
Proposal No. IBD-0122R
Principal Investigator: John H. Kwon, M.D., (replacement PI); Philip M. Ginsburg, M.D. (original PI)
Applicant Organization: Johns Hopkins University (Baltimore, Maryland, U.S.A.)
Project Title: Differentiating fibrostenosing from inflammatory small bowel disease in patients with Crohn's disease using combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography
Period of Award: September 1, 2004 - December 31, 2005
Crohn’s disease (CD) is characterized by different sub-types, including patients with fibrostenosing disease who develop bowel strictures. Approximately half of all patients with fibrostenosing CD undergo surgery for obstructive symptoms. Some have fixed fibrotic strictures that will not improve, and may even be made worse, with infliximab anti-tumor necrosis factor (TNF) therapy. Others have narrowings due to active inflammation that could respond to infliximab therapy. However, no single test is available that reliably differentiates between these two causes of bowel narrowing and obstructive symptoms.
Initial data suggest that positron emission tomography (PET) may be used to localize gastrointestinal inflammation. Recently, combination in-line PET and computed tomography (CT) scanners have been developed that more precisely characterize and localize lesions. We propose a study that examines the accuracy of PET/CT at differentiating fibrostenosing from inflammatory bowel disease by comparing PET/CT findings to resected tissue samples in CD patients who require surgery for obstructing symptoms. If PET/CT scans correlate with histopathologic findings, then future patient management may be significantly affected. Surgery for medically treatable inflammatory disease could be potentially avoided and clinical decisions may be influenced regarding the use of infliximab, a novel biologic agent, in patients with obstructing symptoms.