Mesenteric blood flow is related to disease activity and risk of relapse in Crohn's disease: A prospective follow-up study

OBJECTIVE: The diagnostic significance of increased splanchnic blood how in Crohn's disease is unclear. This prospective study was therefore undertake n to define the role of Doppler sonography in the assessment of disease act ivity and in the prediction of early relapse. METHODS: Splanchnic flowmetry was performed in 59 patients with Crohn's dis ease and 20 healthy volunteers during fasting and 30 min after ingestion of a standardized meal. Twenty-one patients measured during the active stale and in clinical remission were followed-up for 6 months. Hemodynamic parame ters of the superior and inferior mesenteric arteries and the portal vein w ere related to clinical (Crohn's disease activity index [CDAI]), laboratory (C-reactive protein), and endoscopic (Crohn's Disease Endoscopic Index of Severity) parameters of disease activity. RESULTS: The postprandial mean velocity of the superior mesenteric artery c orrelated closest with clinical activity (CDAI, p < 0.005) and C-reactive p rotein (p < 0.01), but was unrelated to endoscopic activity. All patients i n remission after 6 months (9/9) showed an increase in postprandial pulsati lity index of the superior mesenteric artery, compared with an initial meas urement during active disease (+28%). In contrast, the majority of patients with later relapse or surgery (11/12) had decreased pulsatility index duri ng initial remission (-20%). The positive predictive value of this index fo r maintenance of remission was 0.82. CONCLUSIONS: Postprandial flow measurements in the superior mesenteric arte ry are closely related to clinical but not endoscopic disease activity in p atients with Crohn's disease. The repeated measurement of the postprandial pulsatility index allows estimation of the risk of recurrence. (C) 1999 by Am. Coll. of Gastroenterology.