Alimentary TractSurrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease☆,☆☆
Section snippets
Patients
Eighty consecutive patients, 43 with CD and 37 with UC, diagnosed 2-18 years previously by conventional endoscopic, radiologic, and histologic criteria21 who had been in clinical remission between 1 and 4 months, as determined from clinical disease activity indices and were attending a gastroenterology clinic as part of routine follow-up were recruited to the study. Patient characteristics within each group are shown in Table 1.
Results
Table 2 shows the laboratory parameters at the time of inclusion to the study for the patients with CD and UC.Laboratory parameter CD UC ESR (mm/h)a (NL 1-10 mm/h) 16 (7-30) 16 (8-27) CRP (mg/L) (NL <5.0 mg/L) 10.2 (5.3-27) 8.1 (3-16) Fecal calprotectin (mg/L)b (NL <10 mg/L) 95.0 (41-142) 58.0 (28-124) Lactulose/L-rhamnose ratiob (NL <0.05) 0.058 (0.029-0.11) — aMedian (IQ range). bMedian (range).
Discussion
The course of IBD is one of relapse and remission. This study has shown that direct assessment of intestinal inflammation using fecal calprotectin can usefully identify most of those patients who developed a clinical or symptomatic relapse of disease. In patients with CD, the lactulose/L-rhamnose ratio was also predictive of relapse. However, using the Cox model, we have shown that because of the superior ability of fecal calprotectin to predict relapse in such patients, a small intestinal
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Address requests for reprints to: Jeremy Tibble, M.D., Department of Gastroenterology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, BN2 5BE England. e-mail: [email protected].
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Supported by a Research and Development grant from the South Thames NHS executive, London (to J.A.T.).