Issue 02

Clinical Question

Is there a non-invasive surveillance option to detect postoperative recurrence in asymptomatic patients with Crohn’s disease (CD)?

Editor’s Bottom Line

Yes – fecal calprotectin levels!

Reference

Boschetti G, Laidet M, Moussata D, et al. Levels of fecal calprotectin are associated with the severity of postoperative endoscopic recurrence in asymptomatic patients with Crohn’s disease. Am J Gastroenterol. 2015 Jun;110(6):865–72. https://www.ncbi.nlm.nih.gov/pubmed/25781366

Synopsis

Following curative ileocolic resection and ileocolonic anastomosis, patients who were asymptomatic (Harvey Bradshaw Index [HBI] ≤3) prior to their 18 months postoperative colonoscopy for monitoring disease activity were recruited consecutively. Fecal calprotectin (fCal) and high-sensitivity C-reactive protein (CRP) were measured in the week before colonoscopy. A medical chart review was also performed.

The 86 patients (mean age: 39 years) had a mean HBI of 0.85, 14% smoked, average duration of CD was 15.3 years, 16.3% had perianal lesions, and 62.8% were on concomitant therapies, 33% of whom were taking biologics. Endoscopic disease remission (Rutgeerts score i0 or i1) was reported for 50% while moderate and severe endoscopic recurrence was present in 18.6% and 31.4% of patients respectively. FCal levels were significantly higher by 4-fold in those with endoscopic recurrence (P<0.0001). CRP levels increased 2.5-fold in those with endoscopic recurrence (P<0.0014).

With a cut-off of 50 µg/g of fCal, giving a 98% sensitivity and 33% specificity, nearly one third of asymptomatic patients could avoid postoperative colonoscopy yet be confident that they were in endoscopic remission.

Details

Study Design: Prospective observational cohort
Funding: None.
Allocation: n/a
Setting: 3 tertiary centres in France
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.