OBJECTIVE: Endoscopically confirmed mucosal healing has become an important therapeutic goal in the treatment of Crohn's disease (CD). The role of clinical indices, such as the Crohn's disease activity index (CDAI) and the Harvey-Bradshaw index (HBI), and surrogate markers, such as C-reactive protein (CRP) and fecal calprotectin, to indicate remission determined by endoscopy needs to be clarified. We analyzed the role of surrogate markers and clinical indices, separately and in combination, by comparing them with endoscopically scored disease activity in biologically treated CD patients. MATERIAL AND METHODS: Prospectively collected data of all patients with inflammatory bowel disease treated with tumor necrosis factor alpha antibodies in a tertiary center between 2007 and 2010. Altogether 210 endoscopies in 64 CD patients were analyzed. The simple endoscopic score for Crohn's disease (SES-CD) was used for scoring disease activity and compared with available data on concurrent CDAI, HBI, CRP, and calprotectin. RESULTS: Endoscopic activity demonstrated a stronger correlation with calprotectin and CRP than with the clinical indices. Neither the clinical indices nor CRP was reliable at identifying endoscopic remission. However, calprotectin alone identified endoscopic remission with a sensitivity of 84% and specificity of 74%, but was beaten, although not statistically significantly, by a combined index, based on calprotectin and the HBI. CONCLUSIONS: Clinical scores commonly used in the assessment of disease activity are unreliable at differentiating endoscopic remission from active CD. Despite this, a score based on a combination of fecal calprotectin and the HBI is a new promising tool for identifying endoscopic remission.
OBJECTIVE: Endoscopically confirmed mucosal healing has become an important therapeutic goal in the treatment of Crohn's disease (CD). The role of clinical indices, such as the Crohn's disease activity index (CDAI) and the Harvey-Bradshaw index (HBI), and surrogate markers, such as C-reactive protein (CRP) and fecal calprotectin, to indicate remission determined by endoscopy needs to be clarified. We analyzed the role of surrogate markers and clinical indices, separately and in combination, by comparing them with endoscopically scored disease activity in biologically treated CDpatients. MATERIAL AND METHODS: Prospectively collected data of all patients with inflammatory bowel disease treated with tumor necrosis factor alpha antibodies in a tertiary center between 2007 and 2010. Altogether 210 endoscopies in 64 CDpatients were analyzed. The simple endoscopic score for Crohn's disease (SES-CD) was used for scoring disease activity and compared with available data on concurrent CDAI, HBI, CRP, and calprotectin. RESULTS: Endoscopic activity demonstrated a stronger correlation with calprotectin and CRP than with the clinical indices. Neither the clinical indices nor CRP was reliable at identifying endoscopic remission. However, calprotectin alone identified endoscopic remission with a sensitivity of 84% and specificity of 74%, but was beaten, although not statistically significantly, by a combined index, based on calprotectin and the HBI. CONCLUSIONS: Clinical scores commonly used in the assessment of disease activity are unreliable at differentiating endoscopic remission from active CD. Despite this, a score based on a combination of fecal calprotectin and the HBI is a new promising tool for identifying endoscopic remission.
Authors: Jesica C Makanyanga; Doug Pendsé; Nikolaos Dikaios; Stuart Bloom; Sara McCartney; Emma Helbren; Elaine Atkins; Terry Cuthbertson; Shonit Punwani; Alastair Forbes; Steve Halligan; Stuart A Taylor Journal: Eur Radiol Date: 2013-09-12 Impact factor: 5.315
Authors: Phillip Minar; Yael Haberman; Ingrid Jurickova; Ting Wen; Marc E Rothenberg; Mi-Ok Kim; Shehzad A Saeed; Robert N Baldassano; Michael Stephens; James Markowitz; Joel Rosh; Wallace V Crandall; Melvin B Heyman; David R Mack; Anne M Griffiths; Susan S Baker; Jeffrey S Hyams; Subra Kugathasan; Lee A Denson Journal: Inflamm Bowel Dis Date: 2014-06 Impact factor: 5.325
Authors: James Turvill; Lisa Rook; Maxine Rawle; Gerry Robins; Simon Smale; Prashant Kant; Anne Phillips Journal: Frontline Gastroenterol Date: 2017-01-30
Authors: Mahmoud H Mosli; Guangyong Zou; Sushil K Garg; Sean G Feagan; John K MacDonald; Nilesh Chande; William J Sandborn; Brian G Feagan Journal: Am J Gastroenterol Date: 2015-05-12 Impact factor: 10.864
Authors: Reena Khanna; Sigrid A Nelson; Brian G Feagan; Geert D'Haens; William J Sandborn; G Y Zou; John K MacDonald; Claire E Parker; Vipul Jairath; Barrett G Levesque Journal: Cochrane Database Syst Rev Date: 2016-08-08