Crohn's disease: monitoring disease activity

Sostegni, R.; Daperno, Marco; Scaglione, Nadia; Lavagna, A.; Rocca, Rodolfo; Pera, A.

doi:10.1046/j.1365-2036.17.s2.17.x

Cited by 197 publications

(131 citation statements)

References 34 publications

(30 reference statements)

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“…In the absence of a " gold standard " for the measurement of disease activity, severity is established on clinical parameters, systemic manifestations, and the global impact of the disease on the individual ' s quality of life (44,78,79) . Additional factors that impact on therapy include the assessment of growth and nutrition, extraintestinal complications, therapy-induced complications, functional ability, social and emotional support and resources, and education about the disease (77) .…”

Section: Determining Disease Activitymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Determining Disease Activitymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…In the past, this evaluation was based on clinical indexes, mainly the Crohn's Disease Activity Index (CDAI), integrated by laboratory parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and orosomucoids, and endoscopic findings [2,3]. Indeed, endoscopy can assess only mucosal inflammation, which, in a transmural disease like CD, might not be enough [4].…”

Section: Introductionmentioning

confidence: 99%

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Cappello

Tudisca

et al. 2014

Radiol med

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Purpose Few studies have correlated computed tomography enterography (CTE) findings with Crohn's disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity. Materials and methods The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and complications related to the disease (fistulas, strictures, abscesses). Activity was assessed using the Crohn's Disease Activity Index (CDAI) and some biochemical markers (Creactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correlations between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression. Results CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03). Conclusion The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clinically active and that these patients may require more aggressive treatment than patients without these findings.

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“…1 , 2 , 3 , 4 , 5 , 6 Although considered the gold standard method for assessment of intestinal inflammation, ileo-colonoscopy has the disadvantage of being invasive, time-consuming, expensive, and sometimes uncomfortable for patients.…”

Section: Introductionmentioning

confidence: 99%

Fecal Calprotectin Correlates More Closely With the Simple Endoscopic Score for Crohn's Disease (SES-CD) than CRP, Blood Leukocytes, and the CDAI

Schoepfer

Beglinger

Straumann

et al. 2010

American Journal of Gastroenterology

502

352

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OBJECTIVES:Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn's disease (SES-CD) and noninvasive markers are scarce. The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin, C-reactive protein (CRP), blood leukocytes, and the Crohn's disease activity index (CDAI).METHODS:Crohn's disease patients undergoing complete ileocolonoscopy were prospectively enrolled and scored independently according to the SES-CD and the CDAI. SES-CD was defined as follows: inactive 0-3; mild 4-10; moderate 11-19; and high >/=20.RESULTS:Values in CD patients (n=140 ileocolonoscopies) compared with controls (n=43) are as follows: calprotectin, 334+/-322 vs. 18+/-5 mug/g; CRP, 26+/-29 vs. 3+/-2 mg/l; and blood leukocytes, 9.1+/-3.4 vs. 5.4+/-1.9 g/l (all P<0.001). The SES-CD correlated closest with calprotectin (Spearman's rank correlation coefficient r=0.75), followed by CRP (r=0.53), blood leukocytes (r=0.42), and the CDAI (r=0.38). Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity (104+/-138 vs. 231+/-244 mug/g, P<0.001), mild from moderate activity (231+/-244 vs. 395+/-256 mug/g, P=0.008), and moderate from high activity (395+/-256 vs. 718+/-320 mug/g, P<0.001). The overall accuracy for the detection of endoscopically active disease was 87% for calprotectin (cutoff 70 mug/g), 66% for elevated CRP, 54% for blood leukocytosis, and 40% for the CDAI >/=150.CONCLUSIONS:Fecal calprotectin correlated closest with SES-CD, followed by CRP, blood leukocytes, and the CDAI. Furthermore, fecal calprotectin was the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring.

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Crohn's disease: monitoring disease activity

Cited by 197 publications

References 34 publications

Management of Crohn's Disease in Adults

Management of Crohn's Disease in Adults

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Fecal Calprotectin Correlates More Closely With the Simple Endoscopic Score for Crohn's Disease (SES-CD) than CRP, Blood Leukocytes, and the CDAI

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