Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2017; 23(6): 1018-1029
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1018
Cerebral magnetic resonance imaging in quiescent Crohn’s disease patients with fatigue
Sanne van Erp, Ece Ercan, Perla Breedveld, Lianne Brakenhoff, Eidrees Ghariq, Sophie Schmid, Matthias van Osch, Mark van Buchem, Bart Emmer, Jeroen van der Grond, Ron Wolterbeek, Daniel Hommes, Herma Fidder, Nic van der Wee, Tom Huizinga, Désirée van der Heijde, Huub Middelkoop, Itamar Ronen, Andrea van der Meulen-de Jong
Sanne van Erp, Lianne Brakenhoff, Daniel Hommes, Andrea van der Meulen-de Jong, Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Ece Ercan, Perla Breedveld, Eidrees Ghariq, Sophie Schmid, Matthias van Osch, Itamar Ronen, C.J. Gorter Center, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Ece Ercan, Perla Breedveld, Eidrees Ghariq, Sophie Schmid, Matthias van Osch, Mark van Buchem, Bart Emmer, Jeroen van der Grond, Itamar Ronen, Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Ron Wolterbeek, Department of Medical Statistics, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Daniel Hommes, Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, CA 90095, United States
Herma Fidder, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht 3584 CX, the Netherlands
Nic van der Wee, Department of Psychiatry, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Tom Huizinga, Désirée van der Heijde, Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Huub Middelkoop, Department of Neuropsychology, Leiden University Medical Center, Leiden, Zuid-Holland 2333 ZA, the Netherlands
Author contributions: Van Erp S and Ercan E contributed equally to this work; Brakenhoff L, Hommes D, Middelkoop H, Ronen I and van der Meulen-de Jong A designed the research; Ercan E, Brakenhoff L, Hommes D, Fidder H, Huizinga T, van der Heijde D and van der Meulen-de Jong A treated patients and collected material and clinical data from patients; van Erp S, Ercan E, Breedveld P and Brakenhoff L performed the research; van Buchem M, Emmer B and van der Grond J contribed new analytic tools; van Erp S, Ercan E, Breedveld P, Brakenhoff L and Wolterbeek R analysed the data; van Erp S and Ercan E wrote the paper; all authors contributed to critical revision of the manuscript and final approval of the submitted manuscript.
Institutional review board statement: This study was approved by the institutional medical ethical committee of the LUMC.
Informed consent statement: All patients signed a written informed consent prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sanne van Erp, Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands. s.j.h.van_erp@lumc.nl
Telephone: +31-71-5262915 Fax: +31-71-5248115
Received: August 26, 2016
Peer-review started: August 28, 2016
First decision: October 10, 2016
Revised: November 14, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 14, 2017
Processing time: 169 Days and 23.7 Hours
Abstract

AIM

To evaluate brain involvement in quiescent Crohn’s disease (CD) patients with fatigue using quantitative magnetic resonance imaging (MRI).

METHODS

Multiple MRI techniques were used to assess cerebral changes in 20 quiescent CD patients with fatigue (defined with at least 6 points out of an 11-point numeric rating scale compared with 17 healthy age and gender matched controls without fatigue. Furthermore, mental status was assessed by cognitive functioning, based on the neuropsychological inventory including the different domains global cognitive functioning, memory and executive functioning and in addition mood and quality of life scores. Cognitive functioning and mood status were correlated with MRI findings in the both study groups.

RESULTS

Reduced glutamate + glutamine (Glx = Glu + Gln) concentrations (P = 0.02) and ratios to total creatine (P = 0.02) were found in CD patients compared with controls. Significant increased Cerebral Blood Flow (P = 0.05) was found in CD patients (53.08 ± 6.14 mL/100 g/min) compared with controls (47.60 ± 8.62 mL/100 g/min). CD patients encountered significantly more depressive symptoms (P < 0.001). Cognitive functioning scores related to memory (P = 0.007) and executive functioning (P = 0.02) were lower in CD patients and both scores showed correlation with depression and anxiety. No correlation was found subcortical volumes between CD patients and controls in the T1-weighted analysis. In addition, no correlation was found between mental status and MRI findings.

CONCLUSION

This work shows evidence for perfusion, neurochemical and mental differences in the brain of CD patients with fatigue compared with healthy controls.

Keywords: Magnetic resonance imaging; Systemic inflammation; Fatigue; Crohn’s disease; Cognition

Core tip: The present study explores perfusion, neurochemical and mental differences in the brain of Crohn’s disease (CD) patients compared with healthy controls. This implies that for a gastroenterologist it is important to focus, besides gastrointestinal symptoms due to inflammation, on the effects of systemic inflammation on the brain and mental status. Knowledge and understanding of these effects in CD patients may help health professionals to set up interventions to maintain CD remission and improve mental status by e.g. psychosocial interventions.