Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers

Abstract

Objective. The present population based adult cohort was part of a new prospective study of patients with inflammatory bowel disease (IBD) in South-Eastern Norway, the Inflammatory Bowel South-Eastern Norway II study, investigating disease characteristics in an attempt to improve our knowledge regarding factors related to early clinical phenotype and disease activity. Material and methods. Patients suspected to have IBD on the basis of predefined symptoms, including abdominal pain, diarrhea, and/or blood in stool for more than 10 days were examined at the local hospital. Colonoscopy with biopsies was performed and blood and stool samples were taken. Results. In ulcerative colitis (UC) patients, the median Simple Clinical Colitis Activity Index (SCCAI) was 4 (range 0–10) in mild and 6 (range 0–14) in patients with moderate or severe endoscopic activity of inflammation (p = 0.002). The calprotectin concentration in feces was significantly related to the SCCAI (p = 0.034) and the Mayo endoscopic subscore (p = 0.031). There was a significant association between the C-reactive protein (CRP) value, leucocytes and thrombocytes and the SCCAI, but only leucocytes were significantly associated with the Mayo endoscopic subscore. In Crohn's disease (CD) patients, there was no statistical significant association between the Harvey-Bradshaw Index (HBI) and the endoscopic grade of mucosal inflammation (p = 0.8). The calprotectin concentration in feces was significantly related to the endoscopic activity score (p = 0.004), but not to the HBI (p = 0.5). HBI was significantly related to the CRP value (p = 0.047) and thrombocytes (p = 0.03). Conclusions . In UC, both biochemical and fecal markers are related to disease activity and extent of disease, whereas in CD, the fecal calprotectin concentration is a reliable marker of mucosal affection, but not for systemic disease activity.

Key Words::

• Crohn's disease
• Harvey-Bradshaw Index
• Inflammatory Bowel South-Eastern Norway II
• Simple Clinical Colitis Activity Index
• ulcerative colitis

Acknowledgments

We thank our colleagues at the Endoscopic Unit at Akershus University Hospital for their participation in the study, Jorun Bratlie, Oslo University Hospital, Rikshospitalet, for expert technical assistance, Gunn Seim-Ekeland, Akershus University Hospital, for excellent assistance with the protocol, Ellen Gussiås, Elseber Jørgensen, and Toril Sandvold, Akershus University Hospital, for invaluable assistance at the Endoscopic Unit, Solveig Norheim Andersen, Department of Pathology, Akershus University Hospital, and also the staff at our collaborating hospitals within the IBSEN II study. This work was supported by grants from HelseSør RHF (the IBSEN II study).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.