Clinical Remission in Crohn’s Disease – Assessment Using Faecal ¹¹¹ln Granulocyte Excretion

Abstract

The value of the Crohn’s disease activity index (CDAI) in defining clinical remission in Crohn’s disease has been assessed in 71 studies using a new method to quantitate gut inflammatory activity: faecal ¹¹¹In-labelled granulocyte excretion. The range of faecal ¹¹¹In granulocyte excretion in the irritable bowel syndrome was found to be 0.2–1.9% (mean ± SD 0.98 ± 0.55%) of injected dose. 63 (89%) of studies with a CDAI less than 150 and 88% of studies with a serum albumin greater than 35 g/l had faecal ¹¹¹ln granulocyte excretion above the upper limit found in the irritable bowel syndrome ranging from 2.4% to 40%. This study shows that the majority of patients with Crohn’s disease in clinical remission have significant gut inflammatory activity. Whether treatment of this activity will alter the natural history of the disease needs prospective evaluation.

Non-invasive investigation of inflammatory bowel disease

“…When combined with measurement of the 4 day faecal [25,27] . It has also been used to define a number of enteropathies (NSAIDs, alcohol, chronic renal failure, hypogammaglobulinaemia, HIV-AIDS, etc.)…”

“…Many patients with IBD in full clinical remission are shown to have significant intestinal inflammation [27,33] . At present treatment is non-specifically directed at maintaining remission (5-ASA, azathioprine, etc.).…”

“…Symptoms of inflammatory bowel disease often appear to be the direct consequence of the inflammatory process itself and often vary dependent upon Tibble JA, et al, Non-invasive investigation of inflammatory bowel diseasethe location of the inflammation. Most patients with quiescent IBD have low-grade inflammation [27] and it is possible that symptomatic relapse occurs only when the inflammatory process reaches a critical intensity. Furthermore, as inflammation is a continuous process it may be that direct assessment of the level of inflammatory activity may provide a quantitative pre-symptomatic measure of imminent clinical relapse of the disease.…”

Efficacy and Safety of Azathioprine Therapy in Turkish Patients with Inflammatory Bowel Disease: A Retrospective Long Term Follow Up Study

“…Fi nally CDAI may not ac cu rately ref lect the di se a se ac ti vity in pos to pe ra ti ve pa ti ents. 35,36 The se may exp la in why an im por tant pro por ti on of our pa ti ents had a CDAI <150 be fo re AZA tre at ment (Tab le 3). (In the se pa ti ents we perfor med en dos co pic fol low up to mo ni tor res pon se to tre at ment).…”

Semiquantitative fecal calprotectin test in postinfectious and non-postinfectious irritable bowel syndrome: cross-sectional study

“…Patients with clinically quiescent inflammatory bowel disease have some degree of mucosal inflammation, 4 as proved by high levels of fecal calprotectin. For example, Sipponen et al reported that there were high levels of calprotectin (up to 1000 mcg/g) in 13% of their inflammatory bowel disease patients who were in clinical remission.…”