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P134 Is faecal calprotectin a useful marker of postoperative recurrence in Crohn's ileal disease?
Clinical: Diagnosis and outcome
S63
in 183 patients. Montreal phenotypes of luminal disease at referral was not different between groups. Results are summarized in the table. Anal lesions
Ulcerations (N = 67)
Ulcerations & fistulas (N = 87)
Fistulas (N = 31)
No lesion (N = 97)
p
Mean age (y) (m±sd) Disease duration (m) (m±sd) Body Mass Index (m±sd) Intestinal resection (%) No biotherapy (%) Biotherapy, previous/current/after Harvey Bradshaw (m±sd) PDAI (m±sd) Anal stenosis (%)
35±17 97±99 21.6±3.8 10 (14.9) 13 (19.4) 26/18/10 7.4±5.3 6.1±4.4 12 (17.9)
34.3±16 90±98 21.6±4.3 19 (21.8) 23 (26.4) 38/21/5 7.1±4.8 9.5±5 28 (32.1)
39.3±12 145±120 24.3±4.3 15 (48.4) 11 (35.5) 18/1/1 3.1±2.9 2.9±3.6 6 (19.4)
40.1±2 115±90 25.1±6.3 31 (40) 52 (53.6) 40/3/2 3.9±3.7 0±1 3 (3.1)
<0.05 <0.05 0.001 0.002 0.0001 0.0001 0.001 0.001 0.001
Conclusions: There is no link between luminal and anal phenotypes as regard to the types of intestinal lesions and sites. However, patients with anal ulcerations suffered from a more severe disease activity on both luminal (IMC, HB) and anal locations (PDAI, stenosis). This may be taken into account to plan therapeutic strategies such as biotherapies. P133 Fecal calprotectin and CRP as biomarkers of endoscopic activity in Crohn’s disease: A meta-study V. Bondjemah1 *, J.Y. Mary2 , J. Jones3 , W. Sandborn4 , A. Schoepfer5 , E. Louis6 , T. Sipponen7 , A. Vieira8 , J.-F. Colombel9 , M. Allez10 . 1 Beaujon, France, 2 DBIM, Hˆ opital Saint Louis, Inserm U 717, Paris, France, 3 Mayo clinic, Rochester, United States, 4 University of California, San Diego, La Jolla, United States, 5 Farncombe Family Institute of Digestive Health Research, McMaster University, Hamilton, Canada, 6 University of Li` ege and CHU Li` ege, Department of Gastroenterology, Li` ege, Belgium, 7 Helsinki University Central Hospital and Haartman Institute, Helsinki, Finland, 8 1Clinic of Gastroenterology, S˜ ao Paulo, Brazil, 9 Centre Hospitalier Universitaire de Lille, Hˆ opital Claude Huriez, Lille, France, 10 Saint-Louis Hospital, Gastroenterology, Paris, France Background: In patients with CD, endoscopy is useful (a) to confirm the presence of active lesions in symptomatic patients; (b) to confirm mucosal healing in patients in clinical remission. However, endoscopy is invasive and surrogate biomarkers may be useful in that setting. Aim: To assess the correlation between CRP and calprotectin and endoscopic activity in CD. Methods: A meta-study including six published studies in CD was performed. All studies had endoscopic scores (CDEIS or SES-CD) and CRP and calprotectin measurements performed at endoscopic evaluation. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) to anticipate mucosal healing (using 2 definitions: CDEIS 3 and CDEIS 6) were calculated for each test as well as their associations in two different situations: patients clinically active and patients in clinical remission. An optimal threshold value was proposed for each marker and situation. Results: 551 patients were included. In patients clinically active (CDAI >220) (n = 97), the sensitivity of a CRP 5 mg/l or calprotectin 200 mg/g to anticipate a CDEIS 6 was 83%, the specificity 71%, the PPV ranged from 66 to 81% and NPV from 86 to 73% depending on a prevalence of CDEIS 6 between 40 and 60%. In this situation, 38 to 50 colonoscopies out of 100 could be avoided. In patients in clinical remission (CDAI 150) (n = 355), the sensitivity of the association of CRP 10 mg/l and calprotectin 200 mg/g to anticipate a CDEIS 3 was 78%, the specificity 58%, the PPV ranged from 88% to 65% and NPV from 40% to 73% depending on a prevalence of CDEIS 3 varying between 50 and 80%. In this situation, biomarkers could allow to avoid 30 to 40 out of 100 colonoscopies. Conclusions: CRP and fecal calprotectin reflect endoscopic activity in CD. Appropriate use of these biomarkers could replace endoscopic evaluations in specific situations.
P134 Is faecal calprotectin a useful marker of postoperative recurrence in Crohn’s ileal disease? M.T. Herranz1 *, R. Ruiz-Zorrilla1 , N. Alcaide1 , M.A. Maz´ on1 , S. Lorenzo1 , L. Sancho1 , P. Gil Simon1 , R. Atienza1 , J. Barrio1 . 1 Rio Hortega University Hospital, Gastroenterology Department, Valladolid, Spain Background: Endoscopic evidence of recurrence of Crohn’s disease is up to 80% during the first year after surgery and by 3 to 5 years later, a third part of these patients will present a clinical relapse. The aim of this study is to evaluate the utility of faecal calprotectin as a marker of recurrence in patients with Crohn’s ileal disease who have undergone previous surgical resection. Methods: An observational study which included all patients with Crohn’s ileal disease who had ileal and ileocolonic resection, followed up in an inflammatory bowel disease unit of a tertiary center. Endoscopic evidence of recurrence (ER) is defined as Rugeerts index modified >i2A; clinical relapse (CR) as Harvey index >6. In all the cases the levels of faecal calprotectin (Calprest), CPR and ESR were determined in the days previous to endoscopy. Results: Initially, 55 patients were included, but finally 4 were excluded; 2 because inclomplete endoscopy and 2 due to signs of colonic activity. Of the 51 remaining patiens (57% males), 41% were active smokers, 65% were being treated with thiopurines to prevent the recurrence and 17.7% received anti-TNF treatment (alone or in combination with tiopurines). At the moment of their inclusion in the study 33% of the patients presented CR. 70% of the patients with CR (Harvey >6) had amounts of fecal calprotectin >100, this without statistical significance. There was a progressive increase of the values of faecal calprotectin in relation to the increase in Rugeerts index where p = 0.05. The correlation between faecal calprotectin and ER was 0.437 (p < 0.001). The area below the ROC curve was 0.72 (CI 0.57 0.86) with a significance of 0.007. A value of 100 mg/kg of calprotectin has a sensitivity of 76% (CI 57 94) a specificity of 61% (CI 40 82), positive predictive value of 65% (CI 46 84), negative predictive value of 72% (CI 51 93) for the diagnosis of ER. Conclusions: Faecal calprotectin has a weak correlation with recurrence in Crohn’s ileal diseas, either endoscopic or clinical. Therefore its utility in patients with a Crohn’s ileal disease and previous resection is limited. High amounts of faecal calprotectin could help us suspect a recurrence but other complementary tests would still be necessary in order to determinate the degree of recurrence. P135 Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, CRP or blood leukocytes A. Schoepfer1 *, C. Beglinger2 , A. Straumann2 , E. Safroneeva3 , Y. Romero4 , D. Armstrong5 , C. Schmidt6 , M. Trummler7 , V. Pittet8 , S. Vavricka9 . 1 University hospital Lausanne, Switzerland, 2 University hospital Basel, Switzerland, 3 Institute of Social and Preventive Medicine Universit of Bern, Switzerland, 4 Mayo Clinic Rochester MN, United States, 5 McMaster University, Hamilton, ON, Gastroenterology, Canada, 6 Univesity of Jena, Jena, Germany, 7 Bioanalytic Medical Laboraties, Lucerne, Switzerland, 8 Institute of Social and Preventive Medicine Lausanne, Lausanne, Switzerland, 9 University Hospital Zurich, Zurich, Switzerland Background: Thus far, the correlation of noninvasive markers with endoscopic activity in ulcerative colitis (UC) according to the modified Baron Index is unknown. We aimed to evaluate the correlation between endoscopic activity and fecal calprotectin
S63
in 183 patients. Montreal phenotypes of luminal disease at referral was not different between groups. Results are summarized in the table. Anal lesions
Ulcerations (N = 67)
Ulcerations & fistulas (N = 87)
Fistulas (N = 31)
No lesion (N = 97)
p
Mean age (y) (m±sd) Disease duration (m) (m±sd) Body Mass Index (m±sd) Intestinal resection (%) No biotherapy (%) Biotherapy, previous/current/after Harvey Bradshaw (m±sd) PDAI (m±sd) Anal stenosis (%)
35±17 97±99 21.6±3.8 10 (14.9) 13 (19.4) 26/18/10 7.4±5.3 6.1±4.4 12 (17.9)
34.3±16 90±98 21.6±4.3 19 (21.8) 23 (26.4) 38/21/5 7.1±4.8 9.5±5 28 (32.1)
39.3±12 145±120 24.3±4.3 15 (48.4) 11 (35.5) 18/1/1 3.1±2.9 2.9±3.6 6 (19.4)
40.1±2 115±90 25.1±6.3 31 (40) 52 (53.6) 40/3/2 3.9±3.7 0±1 3 (3.1)
<0.05 <0.05 0.001 0.002 0.0001 0.0001 0.001 0.001 0.001
Conclusions: There is no link between luminal and anal phenotypes as regard to the types of intestinal lesions and sites. However, patients with anal ulcerations suffered from a more severe disease activity on both luminal (IMC, HB) and anal locations (PDAI, stenosis). This may be taken into account to plan therapeutic strategies such as biotherapies. P133 Fecal calprotectin and CRP as biomarkers of endoscopic activity in Crohn’s disease: A meta-study V. Bondjemah1 *, J.Y. Mary2 , J. Jones3 , W. Sandborn4 , A. Schoepfer5 , E. Louis6 , T. Sipponen7 , A. Vieira8 , J.-F. Colombel9 , M. Allez10 . 1 Beaujon, France, 2 DBIM, Hˆ opital Saint Louis, Inserm U 717, Paris, France, 3 Mayo clinic, Rochester, United States, 4 University of California, San Diego, La Jolla, United States, 5 Farncombe Family Institute of Digestive Health Research, McMaster University, Hamilton, Canada, 6 University of Li` ege and CHU Li` ege, Department of Gastroenterology, Li` ege, Belgium, 7 Helsinki University Central Hospital and Haartman Institute, Helsinki, Finland, 8 1Clinic of Gastroenterology, S˜ ao Paulo, Brazil, 9 Centre Hospitalier Universitaire de Lille, Hˆ opital Claude Huriez, Lille, France, 10 Saint-Louis Hospital, Gastroenterology, Paris, France Background: In patients with CD, endoscopy is useful (a) to confirm the presence of active lesions in symptomatic patients; (b) to confirm mucosal healing in patients in clinical remission. However, endoscopy is invasive and surrogate biomarkers may be useful in that setting. Aim: To assess the correlation between CRP and calprotectin and endoscopic activity in CD. Methods: A meta-study including six published studies in CD was performed. All studies had endoscopic scores (CDEIS or SES-CD) and CRP and calprotectin measurements performed at endoscopic evaluation. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) to anticipate mucosal healing (using 2 definitions: CDEIS 3 and CDEIS 6) were calculated for each test as well as their associations in two different situations: patients clinically active and patients in clinical remission. An optimal threshold value was proposed for each marker and situation. Results: 551 patients were included. In patients clinically active (CDAI >220) (n = 97), the sensitivity of a CRP 5 mg/l or calprotectin 200 mg/g to anticipate a CDEIS 6 was 83%, the specificity 71%, the PPV ranged from 66 to 81% and NPV from 86 to 73% depending on a prevalence of CDEIS 6 between 40 and 60%. In this situation, 38 to 50 colonoscopies out of 100 could be avoided. In patients in clinical remission (CDAI 150) (n = 355), the sensitivity of the association of CRP 10 mg/l and calprotectin 200 mg/g to anticipate a CDEIS 3 was 78%, the specificity 58%, the PPV ranged from 88% to 65% and NPV from 40% to 73% depending on a prevalence of CDEIS 3 varying between 50 and 80%. In this situation, biomarkers could allow to avoid 30 to 40 out of 100 colonoscopies. Conclusions: CRP and fecal calprotectin reflect endoscopic activity in CD. Appropriate use of these biomarkers could replace endoscopic evaluations in specific situations.
P134 Is faecal calprotectin a useful marker of postoperative recurrence in Crohn’s ileal disease? M.T. Herranz1 *, R. Ruiz-Zorrilla1 , N. Alcaide1 , M.A. Maz´ on1 , S. Lorenzo1 , L. Sancho1 , P. Gil Simon1 , R. Atienza1 , J. Barrio1 . 1 Rio Hortega University Hospital, Gastroenterology Department, Valladolid, Spain Background: Endoscopic evidence of recurrence of Crohn’s disease is up to 80% during the first year after surgery and by 3 to 5 years later, a third part of these patients will present a clinical relapse. The aim of this study is to evaluate the utility of faecal calprotectin as a marker of recurrence in patients with Crohn’s ileal disease who have undergone previous surgical resection. Methods: An observational study which included all patients with Crohn’s ileal disease who had ileal and ileocolonic resection, followed up in an inflammatory bowel disease unit of a tertiary center. Endoscopic evidence of recurrence (ER) is defined as Rugeerts index modified >i2A; clinical relapse (CR) as Harvey index >6. In all the cases the levels of faecal calprotectin (Calprest), CPR and ESR were determined in the days previous to endoscopy. Results: Initially, 55 patients were included, but finally 4 were excluded; 2 because inclomplete endoscopy and 2 due to signs of colonic activity. Of the 51 remaining patiens (57% males), 41% were active smokers, 65% were being treated with thiopurines to prevent the recurrence and 17.7% received anti-TNF treatment (alone or in combination with tiopurines). At the moment of their inclusion in the study 33% of the patients presented CR. 70% of the patients with CR (Harvey >6) had amounts of fecal calprotectin >100, this without statistical significance. There was a progressive increase of the values of faecal calprotectin in relation to the increase in Rugeerts index where p = 0.05. The correlation between faecal calprotectin and ER was 0.437 (p < 0.001). The area below the ROC curve was 0.72 (CI 0.57 0.86) with a significance of 0.007. A value of 100 mg/kg of calprotectin has a sensitivity of 76% (CI 57 94) a specificity of 61% (CI 40 82), positive predictive value of 65% (CI 46 84), negative predictive value of 72% (CI 51 93) for the diagnosis of ER. Conclusions: Faecal calprotectin has a weak correlation with recurrence in Crohn’s ileal diseas, either endoscopic or clinical. Therefore its utility in patients with a Crohn’s ileal disease and previous resection is limited. High amounts of faecal calprotectin could help us suspect a recurrence but other complementary tests would still be necessary in order to determinate the degree of recurrence. P135 Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, CRP or blood leukocytes A. Schoepfer1 *, C. Beglinger2 , A. Straumann2 , E. Safroneeva3 , Y. Romero4 , D. Armstrong5 , C. Schmidt6 , M. Trummler7 , V. Pittet8 , S. Vavricka9 . 1 University hospital Lausanne, Switzerland, 2 University hospital Basel, Switzerland, 3 Institute of Social and Preventive Medicine Universit of Bern, Switzerland, 4 Mayo Clinic Rochester MN, United States, 5 McMaster University, Hamilton, ON, Gastroenterology, Canada, 6 Univesity of Jena, Jena, Germany, 7 Bioanalytic Medical Laboraties, Lucerne, Switzerland, 8 Institute of Social and Preventive Medicine Lausanne, Lausanne, Switzerland, 9 University Hospital Zurich, Zurich, Switzerland Background: Thus far, the correlation of noninvasive markers with endoscopic activity in ulcerative colitis (UC) according to the modified Baron Index is unknown. We aimed to evaluate the correlation between endoscopic activity and fecal calprotectin