Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn's disease

Björkesten, Clas-Göran af; Nieminen, U; Turunen, Ulla; Arkkila, Perttu; Sipponen, Taina; Färkkilä, Martti

doi:10.3109/00365521.2012.660542

Cited by 134 publications

(93 citation statements)

References 33 publications

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“…Fecal calprotectin (fC) is a marker of mucosal CD activity, correlates with excretion of 111 indium-labelled granulocytes in stool, CRP, faecal lactoferrin 32-36 and predicts active disease at endoscopy [37][38][39] . Despite several limitations it seems a reasonable marker of global inflammatory burden as an endpoint 40 .…”

Section: Discussionmentioning

confidence: 99%

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohnʼs Disease

Menys¹,

Makanyanga²,

Plumb³

et al. 2016

Inflammatory Bowel Diseases

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Objectives: Inflammation related enteric dysmotility has been postulated as a cause for abdominal symptoms in Crohn's disease (CD). We investigated the relationship between MRI-quantified small bowel (SB) motility, inflammatory activity and patient symptom burden.Methods: The Harvey Bradshaw Index (HBI) and fecal calprotectin were prospectively measured in 53 CD patients (median age 35, range 18-78) the day before MRI enterography which included a dynamic (cine), breath-hold motility sequence, repeated to encompass the whole SB volume. A validated registration based motility quantitation technique produced motility maps and regions of interest were drawn to include all morphologically normal SB (i.e. excluding diseased bowel). Global SB motility was correlated with calprotectin, HBI and symptom components (wellbeing, pain, diarrhea). Adjustment for age, sex, smoking and surgical history was made using multivariate linear regression.Results: Median calprotectin was 336 (range 0-1280). Mean HBI, motility mean and motility variance were 3 (range 0-16), 0.33 (0.18 to 0.51) and 0.01 (0.0014 to 0.034) respectively. Motility variance was significantly negatively correlated with calprotectin (Rho = -0.33, P = 0.015), total HBI (rho = -0.45, P <0.001), wellbeing (rho= -0.4, p=0.003), pain (rho = -0.27, p =0.05) and diarrhea (rho= -0.4, p=0.0025). The associations remained highly significant after adjusting for covariates. There was no association between mean motility and calprotectin or HBI (p>0.05).Conclusions: Reduced motility variance in morphologically normal small bowel is associated with patient symptoms and fecal calprotectin levels, supporting the hypothesis that inflammation related enteric dysmotility may explain refractory abdominal symptoms in CD.

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Section: Discussionmentioning

confidence: 99%

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohnʼs Disease

Menys¹,

Makanyanga²,

Plumb³

et al. 2016

Inflammatory Bowel Diseases

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“…(28 ranges from a minimum of 0 to a maximum of 30. Somatization severity was categorized, using the total PHQ-15 score, into high (total PHQ-15 ≥15), medium (10)(11)(12)(13)(14), low (5-9) and minimal (≤4) levels of somatization severity,…”

Section: Definition Of Anxiety or Depressionmentioning

confidence: 99%

“…(6-8) Furthermore, recent observational data from longitudinal studies suggest that mood disorders, including anxiety and depression, may be associated with adverse disease outcomes and reduced quality of life. (9) However, many studies designed to investigate these issues have used clinical disease activity indices to assess disease activity, rather than gold-standard investigations such as ileocolonoscopy or small bowel imaging, or fecal biomarkers of intestinal inflammation and, given that the correlation between these tools and objective measures of inflammation may be variable, (10)(11)(12)(13)(14) the implication of these results is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Poor Correlation Between Clinical Disease Activity and Mucosal Inflammation, and the Role of Psychological Comorbidity, in Inflammatory Bowel Disease

Gracie

Williams

Sood

et al. 2016

American Journal of Gastroenterology

129

123

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“…Both studies observed considerable heterogeneity between the various tests due to a lack of diagnostic methodology standardization as there are so few studies evaluating endoscopic activity. The two studies proposed different cut-offs for FC: 50 µg/g (5,21), 100 µg/g (17,22,23), 250 µg/g (24,25) and 274 µg/g (26), with no agreement on the optimum cut-off level.…”

Section: Introductionmentioning

confidence: 99%

Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohns disease with fecal calprotectin

Morón¹,

Manrique²,

Machancoses³

et al. 2017

Rev Esp Enferm Dig

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Background: Fecal biomarkers, especially fecal calprotectin, are useful for predicting endoscopic activity in Crohn's disease; however, the cut-off point remains unclear. The aim of this paper was to analyze whether faecal calprotectin and M2 pyruvate kinase are good tools for generating highly accurate scores for the prediction of the state of endoscopic activity and mucosal healing.Methods: The simple endoscopic score for Crohn's disease and the Crohn's disease activity index was calculated for 71 patients diagnosed with Crohn's. Fecal calprotectin and M2-PK were measured by the enzyme-linked immunosorbent assay test.Results: A fecal calprotectin cut-off concentration of ≥ 170 µg/g (sensitivity 77.6%, specificity 95.5% and likelihood ratio +17.06) predicts a high probability of endoscopic activity, and a fecal calprotectin cut-off of ≤ 71 µg/g (sensitivity 95.9%, specificity 52.3% and likelihood ratio -0.08) predicts a high probability of mucosal healing. Three clinical groups were identified according to the data obtained: endoscopic activity (calprotectin ≥ 170), mucosal healing (calprotectin ≤ 71) and uncertainty (71 > calprotectin < 170), with significant differences in endoscopic values (F = 26.407, p < 0.01). Clinical activity or remission modified the probabilities of presenting endoscopic activity (100% vs 89%) or mucosal healing (75% vs 87%) in the diagnostic scores generated. M2-PK was insufficiently accurate to determine scores.Conclusions: The highly accurate scores for fecal calprotectin provide a useful tool for interpreting the probabilities of presenting endoscopic activity or mucosal healing, and are valuable in the specific clinical context.

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Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn's disease

Abstract: Clinical scores commonly used in the assessment of disease activity are unreliable at differentiating endoscopic remission from active CD. Despite this, a score based on a combination of fecal calprotectin and the HBI is a new promising tool for identifying endoscopic remission.

Cited by 134 publications

References 33 publications

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohnʼs Disease

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohnʼs Disease

Poor Correlation Between Clinical Disease Activity and Mucosal Inflammation, and the Role of Psychological Comorbidity, in Inflammatory Bowel Disease

Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohns disease with fecal calprotectin

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Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn's disease

Abstract: Clinical scores commonly used in the assessment of disease activity are unreliable at differentiating endoscopic remission from active CD. Despite this, a score based on a combination of fecal calprotectin and the HBI is a new promising tool for identifying endoscopic remission.

Cited by 134 publications

References 33 publications

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohnʼs Disease

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohnʼs Disease

Poor Correlation Between Clinical Disease Activity and Mucosal Inflammation, and the Role of Psychological Comorbidity, in Inflammatory Bowel Disease

Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohns disease with fecal calprotectin

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Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohns disease with fecal calprotectin