Inbar Weinstein-Nakar1, Gili Focht1, Peter Church2, Thomas D Walters2, Guila Abitbol1, Sudha Anupindi3, Laureline Berteloot4, Jessie M Hulst5, Frank Ruemmele4, Daniel A Lemberg6, Steven T Leach7, Ruth Cytter8, Mary-Louise Greer9, Anne M Griffiths2, Dan Turner10. 1. The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel. 2. Division of Pediatric Gastroenterology, Hospital for Sick Children, Toronto, Canada. 3. Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia Pennsylvania. 4. Hôpital Necker Enfants Malades, AP-HP, University René Descartes, PRES Sorbonne Paris Cité, INSERM UMR 1163, Institut Imagine, Paris, France. 5. Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. 6. Paediatric Gastroenterology, Sydney Children's Hospital, Conjoint, University of New South Wales, Sydney, Australia. 7. School of Women's and Children's Health, University of New South Wales, Sydney, Australia. 8. Pediatric Radiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. 9. Department of Diagnostic Imaging, Hospital for Sick Children/Department of Medical Imaging, University of Toronto, Toronto, Canada. 10. The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel. Electronic address: turnerd@szmc.org.il.
Abstract
BACKGROUND & AIMS: Bowel healing is an important goal of therapy for patients with Crohn's disease (CD). Although there have been many studies of mucosal healing, transmural healing (ie, in the bowel wall) has not been investigated in children. We analyzed data from the ImageKids study to determine associations among mucosal, transmural healing and levels of calprotectin and C-reactive protein in children with CD. METHODS: We collected data from a multi-center study designed to develop 2 magnetic resonance enterography (MRE)-based measures for children with CD (6-18 years old). In our analysis of 151 children (mean age, 14.2 ± 2.4 years), all patients underwent MRE and a complete ileocolonoscopic evaluation; fecal levels of calprotectin and blood levels of C-reactive protein were measured. Mucosal healing was defined as simple endoscopic severity index in CD score below 3, transmural healing as an MRE visual analogue score below 20 mm, and deep healing as a combination of transmural and mucosal healing. RESULTS: We identified mucosal healing with transmural inflammation in 9 children (6%), transmural healing with mucosal inflammation in 38 children (25%), deep healing in 21 children (14%), and mucosal and transmural inflammation in 83 children (55%). The median level of calprotectin was lowest in children with deep healing (mean level, 10 μg/g; interquartile range, 10-190 μg/g), followed by children with either transmural or mucosal inflammation, and highest in children with mucosal and transmural inflammation (810 μg/g; interquartile range, 539-1737 μg/g) (P < .001). Fecal level of calprotectin identified children with deep healing with an area under the receiver operating characteristic curve value of 0.93 (95% CI, 0.89-0.98); level of C-reactive protein identified children with deep healing with an area under the receiver operating characteristic curve value of 0.81 (95% CI, 0.71-0.9). A calprotectin cutoff value of 100 μg/g identified children with deep healing with 71% sensitivity and 92% specificity; a cutoff value of 300 μg/g identified children with mucosal healing with 80% sensitivity and 81% specificity. CONCLUSIONS: In a prospective study of children with CD, we found that one-third have healing in only the mucosa or the bowel wall (not both). Levels of fecal calprotectin below 300 μg/identify children with mucosal healing, but a lower cutoff value (below 100 μg/g) is needed to identify children with deep healing. Clinicaltrials.gov no: NCT01881490.
BACKGROUND & AIMS: Bowel healing is an important goal of therapy for patients with Crohn's disease (CD). Although there have been many studies of mucosal healing, transmural healing (ie, in the bowel wall) has not been investigated in children. We analyzed data from the ImageKids study to determine associations among mucosal, transmural healing and levels of calprotectin and C-reactive protein in children with CD. METHODS: We collected data from a multi-center study designed to develop 2 magnetic resonance enterography (MRE)-based measures for children with CD (6-18 years old). In our analysis of 151 children (mean age, 14.2 ± 2.4 years), all patients underwent MRE and a complete ileocolonoscopic evaluation; fecal levels of calprotectin and blood levels of C-reactive protein were measured. Mucosal healing was defined as simple endoscopic severity index in CD score below 3, transmural healing as an MRE visual analogue score below 20 mm, and deep healing as a combination of transmural and mucosal healing. RESULTS: We identified mucosal healing with transmural inflammation in 9 children (6%), transmural healing with mucosal inflammation in 38 children (25%), deep healing in 21 children (14%), and mucosal and transmural inflammation in 83 children (55%). The median level of calprotectin was lowest in children with deep healing (mean level, 10 μg/g; interquartile range, 10-190 μg/g), followed by children with either transmural or mucosal inflammation, and highest in children with mucosal and transmural inflammation (810 μg/g; interquartile range, 539-1737 μg/g) (P < .001). Fecal level of calprotectin identified children with deep healing with an area under the receiver operating characteristic curve value of 0.93 (95% CI, 0.89-0.98); level of C-reactive protein identified children with deep healing with an area under the receiver operating characteristic curve value of 0.81 (95% CI, 0.71-0.9). A calprotectin cutoff value of 100 μg/g identified children with deep healing with 71% sensitivity and 92% specificity; a cutoff value of 300 μg/g identified children with mucosal healing with 80% sensitivity and 81% specificity. CONCLUSIONS: In a prospective study of children with CD, we found that one-third have healing in only the mucosa or the bowel wall (not both). Levels of fecal calprotectin below 300 μg/identify children with mucosal healing, but a lower cutoff value (below 100 μg/g) is needed to identify children with deep healing. Clinicaltrials.gov no: NCT01881490.
Authors: Olga Maria Nardone; Giulio Calabrese; Anna Testa; Anna Caiazzo; Giuseppe Fierro; Antonio Rispo; Fabiana Castiglione Journal: Front Med (Lausanne) Date: 2022-05-23
Authors: Allison D Ta; Nicholas J Ollberding; Rebekah Karns; Yael Haberman; Adina L Alazraki; David Hercules; Robert Baldassano; James Markowitz; Melvin B Heyman; Sandra Kim; Barbara Kirschner; Jason M Shapiro; Joshua Noe; Maria Oliva-Hemker; Anthony Otley; Marian Pfefferkorn; Richard Kellermayer; Scott Snapper; Shervin Rabizadeh; Ramnik Xavier; Marla Dubinsky; Jeffrey Hyams; Subra Kugathasan; Anil G Jegga; Jonathan R Dillman; Lee A Denson Journal: Inflamm Bowel Dis Date: 2021-10-20 Impact factor: 5.325
Authors: Melinda Moriczi; Gemma Pujol-Muncunill; Rafael Martín-Masot; Santiago Jiménez Treviño; Oscar Segarra Cantón; Carlos Ochoa Sangrador; Luis Peña Quintana; Daniel González Santana; Alejandro Rodríguez Martínez; Antonio Rosell Camps; Honorio Armas; Josefa Barrio; Rafael González de Caldas; Mónica Rodríguez Salas; Elena Balmaseda Serrano; Ester Donat Aliaga; Andrés Bodas Pinedo; Esther Vaquero Sosa; Raquel Vecino López; Alfonso Solar Boga; Ana Moreno Álvarez; César Sánchez Sánchez; Mar Tolín Hernani; Carolina Gutiérrez Junquera; Nazareth Martinón Torres; María Rosaura Leis Trabazo; Francisco Javier Eizaguirre; Mónica García Peris; Enrique Medina Benítez; Beatriz Fernández Caamaño; Ana María Vegas Álvarez; Laura Crespo Valderrábano; Carmen Alonso Vicente; Javier Rubio Santiago; Rafael Galera-Martínez; Ruth García-Romero; Ignacio Ros Arnal; Santiago Fernández Cebrián; Helena Lorenzo Garrido; Javier Francisco Viada Bris; Marta Velasco Rodríguez-Belvis; Juan Manuel Bartolomé Porro; Miriam Blanco Rodríguez; Patricia Barros García; Gonzalo Botija; Francisco José Chicano Marín; Enrique La Orden Izquierdo; Elena Crehuá-Gaudiza; Víctor Manuel Navas-López; Javier Martín-de-Carpi Journal: Nutrients Date: 2020-04-07 Impact factor: 5.717
Authors: Marrieth G Rubio; Kofi Amo-Mensah; James M Gray; Vu Q Nguyen; Sam Nakat; Douglas Grider; Kim Love; James H Boone; Dario Sorrentino Journal: World J Gastrointest Pathophysiol Date: 2019-12-31
Authors: Bruno Lima Rodrigues; Márcia Carolina Mazzaro; Cristiane Kibune Nagasako; Maria de Lourdes Setsuko Ayrizono; João José Fagundes; Raquel Franco Leal Journal: World J Gastrointest Endosc Date: 2020-12-16