Detectable Laboratory Abnormality Is Present up to 12 Months Prior to Diagnosis in Patients with Crohn’s Disease

Irwin, James; Ferguson, E. E.; Simms, Lisa A.; Hanigan, Katherine; Doecke, James D.; Langguth, Daman; Arnott, Ashley; Radford‐Smith, Graham

doi:10.1007/s10620-018-5357-0

Cited by 16 publications

(11 citation statements)

References 29 publications

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“…Mean values for the CD cohorts were either much closer to the abnormal range or in the abnormal range as compared to controls, in whom mean values were universally in the high normal range. We have previously observed this together with the trajectory of these pathology tests in CD prior to diagnosis . While specific serological identifiers of ileal CD have not been extensively defined, our results are consistent with a fluctuating chronic inflammatory state together with gastrointestinal blood loss and impaired small bowel function.…”

Section: Discussionsupporting

confidence: 85%

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

Shen

Lord

Doecke

et al. 2019

Aliment Pharmacol Ther

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Summary Background Delays in Crohn's disease (CD) diagnosis are positively associated with ileal location and an increased risk of complications. Aim To develop a simple risk assessment tool to enable primary care physicians to recognise potential ileal CD earlier, shortening the delay to specialist investigation Methods Three cohorts were acquired for this study. Cohort 1 included 61 patients retrospectively identified with ileal CD between 2000 and 2010 and 78 matched controls drawn from a cohort referred for investigation of abdominal symptoms. Cohort 2 included 42 individuals diagnosed with ileal CD and 57 controls identified prospectively. Cohort 3 included an additional 84 individuals with ileal CD and 495 without CD referred for colonoscopy. Clinical symptoms and serological biomarkers were acquired and used to develop a risk prediction algorithm. The algorithm was trained independently on each of the three cohorts and tested on the latter two cohorts. Results Altered bowel habit with abdominal pain combined with derangements in white cell count (WCC), albumin and platelet counts were important features in predicting ileal CD (AUC = 0.92, 95% CI = 0.89‐0.92). This was validated in cohorts 2 (AUC = 0.96, 95% CI = 0.95‐0.98) and 3 (AUC = 0.94, 95% CI = 0.92‐0.96). C‐reactive protein was independently associated with ileal CD but non‐signficant in a multivariate model. Conclusion A web‐based risk stratification tool for ileal CD has been developed from objective and symptom‐based criteria. This tool enables primary care physicians to more confidently request urgent specialist assessment for patients identified as at high risk for ileal CD.

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Section: Discussionsupporting

confidence: 85%

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

Shen

Lord

Doecke

et al. 2019

Aliment Pharmacol Ther

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“…Finally, due to the clinical characteristics of the disease that mimic a gastroenteritis, it is not possible to exclude the presence of reverse causation and confounding. Immunological and inflammatory changes are probably present in IBD subjects prior to the development of the overt symptoms [44] and laboratory abnormalities may be found up to 12 months prior to IBD diagnosis [45]. However, we lack data from laboratory tests, such as faecal calprotectin, that could be useful to determine the amount of reverse causation.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

Perinatal and Antibiotic Exposures and the Risk of Developing Childhood-Onset Inflammatory Bowel Disease: A Nested Case-Control Study Based on a Population-Based Birth Cohort

Canova

Ludvigsson

Domenicantonio

et al. 2020

IJERPH

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The role of early-life environmental exposures on Inflammatory Bowel Disease (IBD) onset remains unclear. We aimed to quantify the impact of perinatal conditions and antibiotic use in the first 6 and 12 months of life, on the risk of childhood-onset IBD, in a birth cohort of the region Friuli-Venezia Giulia (Italy). A nested case-control design on a longitudinal cohort of 213,515 newborns was adopted. Conditional binomial regression models were used to estimate Odds Ratios (OR) with 95% confidence intervals (CI) for all analyzed risk factors. We identified 164 individuals with IBD onset before the age of 18 years and 1640 controls. None of the considered perinatal conditions were associated with IBD. Analyses on antibiotic exposure were based on 70 cases and 700 controls. Risks were significantly higher for children with ≥4 antibiotic prescriptions in the first 6 and 12 months of life (OR = 6.34; 95%CI 1.68–24.02 and OR = 2.91; 95%CI 1.31–6.45, respectively). This association was present only among patients with Crohn’s disease and those with earlier IBD onset. We found that perinatal characteristics were not associated to IBD, while the frequent use of antibiotics during the first year of life was associated to an increased risk of developing subsequent childhood-onset IBD.

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“…Healthcare co-payment exemptions are provided by doctors directly at the moment of IBD diagnosis, and are thus easily obtainable from all subjects affected by this condition. Nevertheless, a limit of this algorithm is linked to the months of delay between the actual beginning of the inflammatory process and the onset of symptoms that then lead to a medical diagnosis [55]. However, owing to the longitudinal study design and the inclusion of children with asthma onset before and after IBD diagnosis, we believe this limit should not have impacted our results.…”

Section: Discussionmentioning

confidence: 99%

Risk of Prevalent Asthma among Children Affected by Inflammatory Bowel Disease: A Population-Based Birth Cohort Study

Amidei

Zingone

Zanier³

et al. 2020

IJERPH

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Literature on the risk of asthma among children with inflammatory bowel disease (IBD) is limited and has reported discording results. To the best of our knowledge, no previous study has evaluated the association between asthma and childhood onset IBD, focusing on pediatric IBD with onset between 10 and 17 years, early-onset IBD (EO-IBD) between 0 and 9 years, and very early-onset IBD (VEO-IBD) between 0 and 5 years, all conditions characterized by different clinical progressions. A nested matched case-control design on a longitudinal cohort of 213,515 newborns was adopted. Conditional binomial regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of asthma among children with IBD compared with controls. We found 162 children with IBD and 1620 controls. Overall, childhood onset IBD was associated with increased risks of being affected by asthma (OR: 1.49 95% CI 1.05–2.12), although a significant risk was only present among males (OR: 1.60 95% CI 1.02–2.51). Children with Crohn’s disease and ulcerative colitis had similarly increased risks, although they failed to attain statistical significance. Risks of asthma based on age at IBD onset were inversely related to age, with the lowest non-significant risks for pediatric IBD and EO-IBD, while children affected by VEO-IBD had the highest risk of asthma (OR: 2.75 95% CI 1.26–6.02). Our study suggests the presence of a higher prevalence of asthma among both male children with IBD and children with VEO-IBD. It could be advisable to pay greater attention to possible respiratory symptoms among these categories at higher risk.

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Detectable Laboratory Abnormality Is Present up to 12 Months Prior to Diagnosis in Patients with Crohn’s Disease

Cited by 16 publications

References 29 publications

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

Perinatal and Antibiotic Exposures and the Risk of Developing Childhood-Onset Inflammatory Bowel Disease: A Nested Case-Control Study Based on a Population-Based Birth Cohort

Risk of Prevalent Asthma among Children Affected by Inflammatory Bowel Disease: A Population-Based Birth Cohort Study

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