Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

Abstract

In adult inflammatory bowel disease (IBD) patients, there is a strong discrepancy between symptoms and biomarkers of inflammation. Data on pediatric IBD patients are conflicting. Therefore, we aimed to investigate the relationship between clinical symptoms and biomarkers of inflammation in pediatric IBD. Patients aged <18 years with previously diagnosed Crohn’s disease (CD) or ulcerative colitis (UC) were included. Clinical disease activity was determined using the abbreviated Pediatric CD Activity Index (aPCDAI) or Pediatric UC Activity Index (PUCAI). Biochemical disease activity was assessed using fecal calprotectin (FC) and C-reactive protein (CRP). In total, 127 patients (62 male; median age 14.9 years) were included (82 CD, 45 UC). FC correlated weakly with total aPCDAI score (rs = 0.32; 95 % CI 0.12–0.51; p = 0.003) and total PUCAI score (rs = 0.36; 95 % CI 0.07–0.62; p = 0.015). Only aPCDAI components abdominal examination and perirectal disease and PUCAI component activity level had a significant correlation with levels of FC. CRP correlated weakly with total aPCDAI score (rs = 0.28; 95 % CI 0.05–0.46; p = 0.012) and aPCDAI components abdominal examination and activity level. No significant correlation was observed between CRP and total PUCAI score (rs = 0.01; 95 % CI −0.34–0.29; p = 0.961) or individual PUCAI components.Conclusion: There is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD. What is Known: • A substantial proportion of asymptomatic pediatric inflammatory bowel disease (IBD) patients have elevated biomarkers of inflammation.• There is a strong discrepancy between symptoms and biomarkers of inflammation in adults with IBD. What is New: • Clinical symptoms are only weakly associated with levels of fecal calprotectin and serum C-reactive protein in children and adolescents with previously diagnosed IBD.• Similarly to adult IBD patients, there is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-016-2762-2) contains supplementary material, which is available to authorized users.

Association of fecal calprotectin concentrations with disease severity, response to treatment, and other biomarkers in dogs with chronic inflammatory enteropathies

“…[33][34][35] Serum CRP concentrations were also evaluated in our study and were found to not correlate with fecal calprotectin concentrations. This is consistent with some studies in human IBD patients showing no correlation between both biomarkers in patients with ulcerative colitis (UC) 36 but contrasts the findings of others where CRP was moderately correlated with fecal calprotectin in patients with Crohn's disease (CD) 33,[35][36][37] or UC, 35,37 and it also agrees with the lack of a correlation between serum calprotectin and CRP in dogs with idiopathic IBD. 11 These findings suggest that the intestinal inflammation in dogs with CIE is not related to the systemic inflammatory response.…”

Inflammatory bowel diseases

“…However, in pediatric patients, the data are contradictory. [13–15] Therefore, C-reactive protein is one of the inflammatory biomarkers used as surrogate markers of endoscopic IBD activity mainly due to the increased cost and low accessibility of endoscopy for monitoring disease activity. [15] Nevertheless, C-reactive protein seems to be less accurate for patients diagnosed with UC in comparison to those with CD, a fact that can be explained by the limitation of inflammation to the mucosa in UC, in comparison to the transmural inflammation pattern in CD.…”

“…[13–15] Therefore, C-reactive protein is one of the inflammatory biomarkers used as surrogate markers of endoscopic IBD activity mainly due to the increased cost and low accessibility of endoscopy for monitoring disease activity. [15] Nevertheless, C-reactive protein seems to be less accurate for patients diagnosed with UC in comparison to those with CD, a fact that can be explained by the limitation of inflammation to the mucosa in UC, in comparison to the transmural inflammation pattern in CD. [16] We found that C-reactive protein was in normal ranges in both our patients with UC at the time of diagnosis, even though the clinical symptoms were much more severe than in the 2 patients diagnosed with CD, where C-reactive protein was encountered to be elevated.…”

Laboratory values in Japanese children with newly diagnosed inflammatory bowel disease

“…Hoekman et al . reported that in children with previously diagnosed IBD, clinical disease activity was only weakly associated with inflammatory markers such as FC and CRP . Neither FC nor blood test results such as CRP or ESR are sufficient in themselves for diagnosis of pediatric IBD.…”

“…14 Hoekman et al reported that in children with previously diagnosed IBD, clinical disease activity was only weakly associated with inflammatory markers such as FC and CRP. 15 Neither FC nor blood test results such as CRP or ESR are sufficient in themselves for diagnosis of pediatric IBD. The present results, however, together with previous findings concerning FC in children with IBD, suggest that laboratory parameters including Alb, CRP, and ESR combined with FC might represent more useful screening for pediatric IBD when the tests are used together rather than alone.…”