Preclinical and Undiagnosed Crohnʼs Disease

Abstract

Little is known on the natural history of Crohn's disease (CD) before diagnosis. By the time the patient is diagnosed, the disease has often produced considerable damage to the intestinal mucosa and sometimes other organs. Such period before diagnosis might involve both a silent and a symptomatic phase. The silent phase, or preclinical CD, might last several years after the biological disease onset. Evidence is accumulating that the symptomatic phase might also go undiagnosed for months or years. In fact, for each established case of CD, there are probably several undiagnosed cases, a classic iceberg phenomenon of disease. Such status quo--lagging behind diagnostic standards for many other diseases--effectively hampers efforts to block disease evolution and the development of complications. This is no longer tenable because CD is a debilitating, severe, and costly affection, whose incidence is rapidly rising worldwide. Here, we will review what is currently known on preclinical and undiagnosed CD and what could be done to improve accuracy and timeliness of diagnosis.

Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients with Crohn’s disease

“…Therefore, early diagnosis, early aggressive therapy, and close monitoring of disease activity are emphasized with the understanding that symptom-based treatment strategies are insufficient to modify the outcomes of disease progression such as intestinal resection [27, 28]. In line with this trend, mucosal healing is currently being emphasized as a treatment target because patients who achieve mucosal healing have a better prognosis than who do not [29, 30].…”

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

“…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.…”

Can David topple Goliath again? The ‘simple’ perianal abscess could provide a key to identifying early Crohn's disease

“…CD is diagnosed in the majority of patients only after they become symptomatic, with the delay between symptoms and disease diagnosis being over 12 months . Symptoms in patients relate to underlying bowel damage and almost all patients have considerable bowel damage at the time of disease diagnosis . In the natural history of CD there is a latent preclinical period between the time of onset of disease and the time of development of symptoms, which may run into months or years .…”

“…There may be a potential to modify the natural course of the CD if medical intervention is initiated during the preclinical period of the disease, as this could potentially prevent bowel damage . Only one case of preclinical CD with follow‐up has been reported, with promising results and improved outcomes .…”