SUMMARY We have investigated the correlation of 24 h and 48 h faecal Indium-lll excretion with each other and with several clinical activity indices for Crohn's disease (CD): Crohn's disease activity index (CDAI), activity index (AI), simple index (SI), Oxford score, and laboratory parameters, such as ESR, serum albumin, orosomucoid, C-reactive protein, alpha-l-antitrypsin (at,-AT) faecal concentration, and al-AT clearance in 58 CD patients (37 with small bowel and 21 with colonic disease). A significant correlation was found between 24 and 48 h faecal Indium-111 excretion for small bowel (r=0.708, p<00001) and colonic disease (r=0.994, p<00001). The median faecal Indium-111 excretion for colonic involvement (4%; 0-15-50% median and range) was significantly (p<00005) higher than that for small bowel disease (0.45%; 0.03-29%). No significant correlation was found between faecal Indium-111 excretion and any activity index in the patients with small bowel disease, while in the group of patients with colonic localisation only the AI showed a significant correlation (r=0-593, p<002). Faecal Indium-ill excretion was significantly correlated with al-AT clearance (r=0.712, p<00001) and faecal ctl-AT concentration (r=0'750, p<00001) in small bowel and in colonic localisation (r=0-530, p<0O02 and r=0.444, p<005). Serum albumin was significantly correlated only in the group of patients with colonic disease (r= -0.593, p<005). The present study shows poor agreement between activity indices, serum parameters of activity and faecal Indium-111 excretion. As a good correlation was found with the al-clearance, which reflects losses into the gut, these results may suggest that faecal Indium excretion does not only reflect activity of inflammation, but may relate to the extent of intestinal ulceration.Crohn's disease is a chronic relapsing disease in which the clinical presentation varies considerably. Difficulties arise in accurately assessing the disease activity which is important in the management of the patient and in analysing prospective trials. Laboratory variables such as erythrocyte sedimentation rate (ESR), serum albumin, C reactive protein and orosomucoid concentrations have been used but are not always reliable because they lack specificity for Crohn's disease.

Since oral lesions appear to occur more commonly in patients with Crohn's disease (CD) than in normal controls or patients with ulcerative colitis, it has been suggested that a deficit of locally produced IgA allows the invasion of the oral mucous membrane by antigens and contributes to the production of oral lesions. In connection with this hypothesis, the concentrations of IgA, IgM, and IgG in whole and parotid saliva were investigated by the ELISA technique in 20 patients with CD and 20 healthy subjects matched for dental status. IgA predominated in whole and parotid saliva in both patients and controls, and in both groups whole saliva had higher levels of IgA, IgM, and IgG than parotid saliva did. Compared with the controls, IgA, IgM, and IgG levels were significantly elevated in the whole saliva of CD patients. However, no correlation was found between immunoglobulin levels and age, sex, therapy, duration, localization, or activity of the disease.

SummaryPlasminogen activators were determined in intestinal tissue, obtained after surgery from patients with Crohn’s disease and ulcerative colitis, and compared with normal intestinal tissue from colorectal cancer patients.The activity and quantity of tissue-plasminogen activator (t-PA) was found to decrease with the severity of inflammation in the patients with inflammatory bowel disease. Urokinase (u-PA) activity, however, was not changed compared with controls or in relation with severity of inflammation. In contrast, the level of u-PA antigen was found to be increased significantly in the inflammatory bowel disease tissues and was also related with severity of inflammation. The difference between u-PA activity and antigen in inflammatory bowel disease tissue could be attributed to an increase in inactive pro-u-PA and u-PA-inhibitor complexes.This increase in u-PA and the concomitant decrease in t-PA, are similar to those found in premalignant colonic adenomas, and might be related to the known increased cancer risk in inflammatory bowel disease.

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The present study was undertaken to determine the value of indium-111 granulocyte scintigraphy in Crohn’s disease of the small bowel by comparing the results with those of radiology, endoscopy and surgery. Twenty-one patients with Crohn’s disease of the small bowel, 9 patients with Crohn’s disease of the colon, 1 patient with both localizations and 8 with ulcerative colitis were studied by indium-111 granulocyte scanning. Eighteen patients had evidence of active small intestinal disease based on clinical, radiologic, and/or endoscopic, and/or histopathological features. Thirteen of them had a true positive scan (sensitivity 72%), but accurate assessment of localization and extent of disease was often difficult. Five patients had a false negative scan and 4 a true negative. No false positive scans were found. The diagnostic accuracy was 77%. In contrast, from 18 patients with colonic disease, 16 had a true positive scan corresponding in localization and extent with standard investigations, 1 patient had a false negative scan (sensitivity 94%), and 1 a true negative (diagnostic accuracy 95%). This study also showed that 3–5 h scanning after injection of indium-111-labeled granulocytes is the optimal timing for this test. The patient’s acceptability of this procedure was definitely superior to radiology and endoscopy. In conclusion, this technique has a definite place in evaluating localization and extent of active colonic disease, but it does not replace good small bowel radiology and should not be recommended in the routine diagnostic workup of Crohn’s disease of the small intestine.