Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring

Benitez, Jose-Manuel; Meuwis, Marie‐Alice; Reenaers, Cathérine; Kemseke, Catherine Van; Meunier, Paul; Louis, Édouard

doi:10.1136/gutjnl-2012-303957

Cited by 103 publications

(87 citation statements)

References 70 publications

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“…Some studies suggest that low 25(OH)D is associated with more active disease, whereas others do not support this premise, based on studies collectively comprising approximately 800 CD participants (Table 1). Understanding this association is complicated by the different parameters applied by studies to capture disease activity, which typically include: (a) clinical activity scores, namely the Crohn's disease activity index (CDAI), currently the gold standard (39) or the HarveyBradshaw index; (40) (b) C-reactive protein (CRP) as a marker of systemic inflammation; (c) faecal calprotectin (41) as a marker of intestinal inflammation. For systemic inflammation, as determined by CRP, current studies broadly agree and show a lack of association with 25(OH)D levels.…”

Section: Vitamin D Status and Associations With Disease Severity In Cmentioning

confidence: 99%

Vitamin D as a novel therapy in inflammatory bowel disease: new hope or false dawn?

O’Sullivan

2014

Proc. Nutr. Soc.

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There is increasing scientific interest in the field of vitamin D research, moving the focus beyond bone health to other disease processes. Low circulating vitamin D levels have been reported as a risk factor for several pathophysiologically divergent diseases, including cancers, diabetes, CVD, multiple sclerosis and inflammatory diseases, including rheumatoid arthritis and inflammatory bowel disease (IBD). But, therein, remains the challenge: can any single nutrient contribute to multiple complex disease mechanisms and, ultimately, have therapeutic potential? The aim of this review is to critically evaluate several strands of scientific evidence surrounding vitamin D and inflammation, primarily focusing on IBD. Epidemiological studies suggest an increased incidence of IBD and rheumatoid arthritis in countries of more northern latitudes, mirroring sunlight patterns. A considerable body of evidence supports the anti-inflammatory effects of vitamin D, at least in animal models of IBD. Although it is accepted that suboptimal vitamin D status is common in IBD, some studies suggest that this associates with more severe disease. With regard to treatment, the data are only beginning to emerge from randomised controlled trials to suggest that people with IBD may remain in remission longer when treated with oral vitamin D. In conclusion, several strands of evidence suggest that vitamin D may modify the immune response in IBD. There is a continued need for large well-designed clinical trials and mechanistic studies to determine if, and how, this emerging promise translates into tangible clinical benefits for people with chronic debilitating diseases such as IBD.

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Section: Vitamin D Status and Associations With Disease Severity In Cmentioning

confidence: 99%

Vitamin D as a novel therapy in inflammatory bowel disease: new hope or false dawn?

O’Sullivan

2014

Proc. Nutr. Soc.

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“…The economic effects of pediatric and adult Crohn disease are staggering and are estimated to be between $10.9 billion and $15.5 billion per year in the United Sates alone (3). Diagnosis and follow-up of small bowel Crohn disease in children and adults are typically based on a combination of patient history and physical examination, disease activity surveys (eg, the Pediatric Crohn's Disease Activity Index), laboratory assessment, endoscopy with biopsy, and imaging (4).…”

Section: Introductionmentioning

confidence: 99%

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

Dillman¹,

Smith

Sanchez³

et al. 2015

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Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population.

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“…These two biomarkers may be combined to improve prediction (14). It should, however, be kept in mind that they are not perfectly correlated with mucosal healing and predictive threshold values for these markers have not fully been established yet (8). Assessment of prognosis with laboratory values generated much interest in the past decade.…”

Section: Discussionmentioning

confidence: 99%

“…Achieving endoscopic healing after medical therapy has been associated with a better disease outcome (8). Mucosal activity assessed by ileocolonoscopy is predictive of requiring abdominal surgery (9) and hospitalisation under under anti-Tumor necrosis factor (TNF) therapy (10) and risk of relapse upon anti-TNF withdrawal (11).…”

Section: Discussionmentioning

confidence: 99%

Role of Inflammatory Markers as Predictors of Clinical Activity and Endoscopic Severity in Crohn’s Disease

Önal

Arhan

Sargın

et al. 2015

GMJ

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Objective: We aim to assess the role of inflammatory markers as predictors of clinical activity and endoscopic severity in Crohn's disease (CD). Methods: Patients attending for colonoscopy with known or suspected CD were recruited. Clinical disease activity was recorded as per the Crohn's Disease Activity Index (CDAI) and endoscopic activity was recorded using the simple endoscopic score (SES) for CD. Receiver operating characteristic analysis (ROC) determined the predictive value and optimal predictive thresholds for the inflammatory markers. Results: The folllowing parameters were significantly different between clinically active CD and CD in remission: SES, C-reactive protein (CRP), white blood cell count (WBC), neutrophil count, hemoglobin, platelet count, albumin and fecal calprotectin (FC). And the following parameters were significantly different between patients with mild (SES<7) and moderate to severe (SES≥7) endoscopic activity: CDAI, WBC, CRP, neutrophil count, albumin and FC. The cut-off value for CRP for the detection of moderate to severe endoscopic activity in CD patients was calculated as ≥11.5 mg/L using ROC analysis [Sensitivity: 70%, specificity: 100%, AUC: 0.790 (0.567-1.013), P=0.028] whereas this cut-off value was 487 µg/g for FC [Sensitivity: 70%, specificity: 90%, AUC: 0.805 (0.598-1.01), P=0.028]. All of the 6 patients with FC >487 µg/g and CRP>11.5 mg/L were found to have moderate to severe endoscopic activity. Conclusion: Increased concentrations of either CRP or FC are predictive of clinical and endoscopic disease activity.

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Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring

Cited by 103 publications

References 70 publications

Vitamin D as a novel therapy in inflammatory bowel disease: new hope or false dawn?

Vitamin D as a novel therapy in inflammatory bowel disease: new hope or false dawn?

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

Role of Inflammatory Markers as Predictors of Clinical Activity and Endoscopic Severity in Crohn’s Disease

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