Biomarker Signature for Crohn’s Disease Stricture Severity

Overview

About this study

The purpose of this study is to develop a mucosal biomarker signature for stricturing small bowel Crohn’s disease (CD) (Aim 1). Also, to validate the mucosal biomarker from objective 1 and validation of novel in vivo and ex vivo imaging techniques for intestinal CD fibrosis.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Stricturing CD Participant Criteria

Inclusion Criteria

  • Male or nonpregnant, nonlactating females, 16 to 80 years of age at the time of the SOC MRE.
  • An established diagnosis of CD by a gastroenterologist[BDHM1] [FJGM2] .
  • Documented symptomatic stricturing small bowel CD in reach of colonoscopy (i.e., a portion of the stricture is located within 15 cm of the ileocecal valve anastomosis).
  • Anastomotic or naïve small bowel CD stricture(s) at the time of  clinically-indicated CT entergraphy (CTE[FJGM3] ) or MRE, where naïve small bowel stricture is defined by the combination of:
    • localized luminal narrowing (luminal diameter reduction of at least 50% relative to normal adjacent bowel loop);  AND
    • bowel wall thickening (25% increase relative to adjacent unaffected bowel); AND
    • either: maximum associated small bowel dilation (luminal diameter greater than 3 cm) OR inability to pass an adult or pediatric colonoscope through the narrowed area prior to dilation and unequivocal proximal small bowel dilation (but may be less than 3 cm[FJGM4] ). Endoscopic diagnosis of stricture should be within 6 months of MRE.
  • An anastomotic stricture is defined the same as a naïve stricture, but at the site of prior intestinal resection with anastomosis.
  • Clinical symptoms consistent with obstruction defined by the S-PRO items including abdominal pain after eating (at least often) and dietary restrictions (at least moderate) within 1 month of the SOC MRE[BDHM5] [FJGM6]  or CTE.
  • Radiologically confirmed CD stricture (CONSTRICT criteria)1 as determined by SOC MRE or CTE performed according to accepted technical parameters [refs].
  • Surgical resection (Aim 1) or SOC endoscopy (Aim 2) of the small bowel stricture scheduled to occur within 3 months of the research MRE.

Exclusion Criteria

  • Internal penetrating disease as shown by fistula, abscess, or inflammatory mass (phlegmon)[FJGM7] . A blind-ending sinus is not excluded.
  • Gastrointestinal malignancies.
  • More than 2 distal ileal strictures at the time of SOC MRE or CTE (where a long segment with multiple areas of narrowing with confluent inflammation between them is counted as 1 stricture, and 2 strictures within 3 cm are counted as a single stricture).
  • A terminal ileal stricture in a patient with end ileostomy, where the stricture is confined within the subcutaneous tissues and does not extend intra-abdominally.
  • A diverting loop ileostomy proximal to the dominant stricture.
  • Total proctocolectomy with an ileoanal or Kock pouch.
  • Stricturoplasty in the distal ileum, which is near or adjacent to a stricture[FJGM8].

UC Control Participant Criteria

Inclusion Criteria

  • Male or nonpregnant, nonlactating females, 16 to 80 years of age.
  • An established diagnosis of UC by a gastroenterologist and confirmed with endoscopy with histology and cross-sectional imaging.
  • Patients with UC that have non-affected areas of the colon (e.g., left-sided colitis) are preferred since this would allow sampling of involved and non-involved segments in the same patient.
  • Prior CTE or MRE showing absence of small bowel inflammation and perianal disease.

Exclusion Criteria

  • Total proctocolectomy with an ileoanal or Kock pouch.
  • Diverting loop ileostomy prior to colectomy.
  • Completion proctectomies after prior segmental colon resection or presence of a Hartmann’s pouch.

Non-IBD Control Participant Criteria

Inclusion Criteria

  • Male or nonpregnant, nonlactating females, 16 to 80 years of age.
  • Patient undergoing colon or small bowel resection.
  • Prior abdominopelvic CT or MRI showing lack of small bowel inflammation, segmental or diffuse colitis and perianal disease.

Exclusion Criteria

  • Diagnosis of IBD.
  • Total proctocolectomy with an ileoanal or Kock pouch.
  • Diverting loop ileostomy upstream of resection.
  • Ongoing chemotherapy or radiotherapy within 3 months of surgery.
  • Completion proctectomies after prior segmental colon resection or presence of a Hartmann’s pouchy.
  • Hereditary colorectal cancer (CRC) diagnosis. Sporadic cases of CRC are permitted to enroll.

Note: Other protocol defined Inclusion/Exclusion Criteria may apply.

Eligibility last updated 10/4/22. Questions regarding updates should be directed to the study team contact.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Rochester, Minn.

Mayo Clinic principal investigator

Joel Fletcher, M.D.

Open for enrollment

Contact information:

Jessica Montgomery

(507) 284-1980

Boyum.Jessica@mayo.edu

More information

Publications

Publications are currently not available