Purpose or Case Report: Magnetic resonance enterography (MRE) uniquely provides anatomic and functional characterization of intestinal morphological abnormalities. Prior adult studies have linked altered small bowel motility to strictures and fibrosis, but pediatric data are limited. It is unclear if motility can predict surgical risk in children with Crohn’s Disease (CD). We aim to evaluate motility in small bowel, its association with clinical phenotype, and surgical outcome in pediatric CD compared to irritable bowel syndrome (IBS) and healthy controls (HC).
Methods & Materials: Pediatric CD patients with macroscopic ileal involvement (Paris classification L1 or L3) who underwent cine-MRE from 2012-2024 were reviewed. Images were anonymized and uploaded to Entrolytics.io by Motilent for post-processing. Two pediatric radiologists identified the proximal, distal, and terminal ileum on dynamic cine-MRE sequences to attain GIQuant motility scores. GIQuant scores were also collected for subjects with IBS and HC, with radiologically normal studies. Patients who had multiple MRE studies were included in a subcohort to analyze longitudinal changes in intestinal motility. Descriptive and regression statistical analysis was done.
Results: A total of 33 CD (median age 14.7), 38 IBS and 9 HC subjects were included. In the CD cohort, 79% had ileocolonic (L3) disease and 21% had ileal (L1) disease. Additionally, 24% had active inflammation, 39% had stricturing and 37% had both stricturing and penetrating pathology. L1 and L3 CD subjects had lower mean GIQuant scores of the terminal ileum (148.3±94.4) than IBS (271.3±112.4) and HC (269.6±74.7) (p< 0.01), while the mean proximal ileum score was lower in CD (293.68±106.83) vs IBS (372.31±117.89) (p< 0.05). CD subjects who underwent surgery had terminal ileum scores similar to those who did not (median 120.3 (IQR 87.1-145.5) vs 130.7 (111.5-221.7)). GIQuant scores did not differ significantly between complicated (B2 or B2/B3) and inflammatory (B1) phenotypes. In the longitudinal analysis (n=12), an increase in terminal ileum GIQuant correlated with an increase in albumin.
Conclusions: Ileal motility is reduced in children with CD compared to IBS and HC, consistent with prior studies. In our cohort, motility differences across CD phenotypes and surgical outcome were minimal. Additional studies are necessary to understand how quantitative motility assessment can provide complementary information on disease characterization in pediatric CD.