Are activity indices helpful in assessing active intestinal inflammation in Crohn's disease?

Abstract

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.

Clinical Relevance of Activity Parameters in Crohn’s Disease Estimated by the Faecal Excretion of ¹¹¹In-Labeled Granulocytes

“…We found a similar correlation between laboratory tests commonly used for the assessment of disease activity in CD and this objective estimate of intestinal inflammation (table 1). This is partly contradictory to findings reported by Crama-Bohbouth et al [9] recently. Their lack of correlation for small bowel involve ment may.…”

Measurement of Fecal Calprotectin Improves Monitoring and Detection of Recurrence of Crohn's Disease After Surgery

“…However, there is often insufficient correlation between the clinical state and biological markers to engender confidence in their use as the sole basis for monitoring or treatment decision-making. 4,5 Endoscopy is the gold standard for detecting and quantifying bowel inflammation, but is expensive, labor intensive, inconvenient for the patient and carries some risk. 6 The correlation between clinical scoring systems, such as the Crohn's Disease Activity Index (CDAI) and the Harvey Bradshaw Index (HBI), and endoscopic findings in Crohn's disease is poor.…”

Assessment of Circulating MicroRNAs for the Diagnosis and Disease Activity Evaluation in Patients with Ulcerative Colitis by Using the Nanostring Technology

“…6 Evaluating IBD disease activity from clinical indices is often inaccurate due to the subjective recording of symptoms. 7 Additionally, most of the imaging techniques are invasive, painful, time-consuming and expensive causing significant burden on the patient. To overcome the above challenges a number of biomarkers is routinely applied in combination to the above methods to facilitate diagnosis and assess disease activity.…”