Anastasios Koulaouzidis1, Sarah Douglas, John N Plevris. 1. Centre for Liver and Digestive Disorders, Endoscopy Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland, UK. akoulaouzidis@hotmail.com
Abstract
BACKGROUND: Small-bowel capsule endoscopy (SBCE) is an invaluable imaging method for the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) have been developed to standardize the reporting of small-bowel inflammation. Fecal calprotectin (FC) represents a highly reliable biomarker of intestinal inflammation. AIM: To assess the performance of the two SBCE inflammation scoring systems by correlating them with FC. Furthermore, to define threshold levels for CECDAI. METHODS: Retrospective study; patients who underwent SBCE and had FC measurement shortly before or after SBCE. LS and CECDAI were calculated by a single reviewer and correlated [Spearman's (r ( s ))] with the FC results. Linear regression analysis was used to identify threshold levels for CECDAI. RESULTS: Forty-nine patients; three subgroups A, B and C (based on FC levels <100, 100-200, and ≥200 μg/g, respectively). LS appears to correlate with FC (r ( s ) = 0.448, p = 0.0014), unlike CECDAI, which does not demonstrate significant correlation (r ( s ) = 0.245, p = 0.089). Strongly positive correlation between FC and LS was observed in subgroup A (r ( s ) = 0.68, p = 0.0047), while in subgroups B and C, neither LS nor CECDAI showed correlation with FC. Significant correlation between LS and CECDAI was demonstrated (r ( s ) = 0. 6324, p < 0.0001). Linear regression analysis demonstrates that LS thresholds of 135 and 790 correspond with CECDAI levels of 3.8 and 5.8, respectively. CONCLUSIONS: LS performs better than CECDAI in describing small-bowel inflammation, especially at FC levels of <100 μg/g. Furthermore, CECDAI levels of 3.8 and 5.8 seem to correspond to LS thresholds of 135 and 790, respectively.
BACKGROUND: Small-bowel capsule endoscopy (SBCE) is an invaluable imaging method for the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) have been developed to standardize the reporting of small-bowel inflammation. Fecal calprotectin (FC) represents a highly reliable biomarker of intestinal inflammation. AIM: To assess the performance of the two SBCE inflammation scoring systems by correlating them with FC. Furthermore, to define threshold levels for CECDAI. METHODS: Retrospective study; patients who underwent SBCE and had FC measurement shortly before or after SBCE. LS and CECDAI were calculated by a single reviewer and correlated [Spearman's (r ( s ))] with the FC results. Linear regression analysis was used to identify threshold levels for CECDAI. RESULTS: Forty-nine patients; three subgroups A, B and C (based on FC levels <100, 100-200, and ≥200 μg/g, respectively). LS appears to correlate with FC (r ( s ) = 0.448, p = 0.0014), unlike CECDAI, which does not demonstrate significant correlation (r ( s ) = 0.245, p = 0.089). Strongly positive correlation between FC and LS was observed in subgroup A (r ( s ) = 0.68, p = 0.0047), while in subgroups B and C, neither LS nor CECDAI showed correlation with FC. Significant correlation between LS and CECDAI was demonstrated (r ( s ) = 0. 6324, p < 0.0001). Linear regression analysis demonstrates that LS thresholds of 135 and 790 correspond with CECDAI levels of 3.8 and 5.8, respectively. CONCLUSIONS:LS performs better than CECDAI in describing small-bowel inflammation, especially at FC levels of <100 μg/g. Furthermore, CECDAI levels of 3.8 and 5.8 seem to correspond to LS thresholds of 135 and 790, respectively.
Authors: Reena Sidhu; David S Sanders; Perm Wilson; Laura Foye; Stephen Morley; Mark E McAlindon Journal: J Gastrointestin Liver Dis Date: 2010-09 Impact factor: 2.008
Authors: Jost Langhorst; Sigrid Elsenbruch; Julia Koelzer; Andreas Rueffer; Andreas Michalsen; Gustav J Dobos Journal: Am J Gastroenterol Date: 2007-10-04 Impact factor: 10.864
Authors: J Tibble; K Teahon; B Thjodleifsson; A Roseth; G Sigthorsson; S Bridger; R Foster; R Sherwood; M Fagerhol; I Bjarnason Journal: Gut Date: 2000-10 Impact factor: 23.059
Authors: Stuart L Triester; Jonathan A Leighton; Grigoris I Leontiadis; Suryakanth R Gurudu; David E Fleischer; Amy K Hara; Russell I Heigh; Arthur D Shiff; Virender K Sharma Journal: Am J Gastroenterol Date: 2006-05 Impact factor: 10.864
Authors: A Bourreille; A Ignjatovic; L Aabakken; E V Loftus; R Eliakim; M Pennazio; Y Bouhnik; E Seidman; M Keuchel; J G Albert; S Ardizzone; S Bar-Meir; R Bisschops; E J Despott; P F Fortun; R Heuschkel; J Kammermeier; J A Leighton; G J Mantzaris; D Moussata; S Lo; V Paulsen; J Panés; G Radford-Smith; W Reinisch; E Rondonotti; D S Sanders; J M Swoger; H Yamamoto; S Travis; J-F Colombel; A Van Gossum Journal: Endoscopy Date: 2009-07-08 Impact factor: 10.093
Authors: Marisol Luján-Sanchis; Laura Sanchis-Artero; Laura Larrey-Ruiz; Laura Peño-Muñoz; Paola Núñez-Martínez; Génesis Castillo-López; Lara González-González; Carlos Boix Clemente; Cecilia Albert Antequera; Ana Durá-Ayet; Javier Sempere-Garcia-Argüelles Journal: World J Gastrointest Endosc Date: 2016-09-16