P226. Non-invasive monitoring of inflammatory bowel disease: Need for better tools?
N. Azzopardi1, P. Ellul1, V. Fenech1
1Mater Dei Hopsital, Gastroenterology Department, Msida, Malta
Background: In inflammatory bowel disease (IBD), biomarkers are used for non-invasive monitoring of disease activity. The commonly used biomarkers are the acute-phase proteins C‑reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR). Ulcerative colitis (UC) is believed to have only a modest to absent CRP response despite active inflammation and the reason for this is unknown. Iron deficiency anaemia (IDA) is also often a marker of longstanding active disease in IBD.
In this study we have analysed the sensitivity and specificity of CRP, ESR and IDA in Crohn's disease (CD) and UC.
Methods: CRP, ESR, Haemoglobin level and Mean Corpuscular Volume taken within 14 days of a colonoscopic examination were analysed. The values were then compared with the histopathological findings from colonic and terminal ileal biopsies.
Results: Colonic biopsies from 95 colonoscopies done in 71 different patients with known UC were analysed (PPV: Positive Predictive Value, NPV: Negative Predictive Value).
|CRP & ESR||75.9%||90%||93.2%||67.5%|
Colonic and terminal ileal biopsies from 98 colonoscopies in 62 different patients with known CD were analysed.
|ESR & CRP||70.9%||70.0%||83.0%||53.8%|
Conclusions: UC has a similar CRP response to CD in active inflammation. The commonly used biomarkers have poor sensitivities in demonstrating active mucosal disease. IDA has little value when used as a marker of disease activity on its own but may be used as an adjunct to ESR and CRP or other biomarkers. Faecal biomarkers like calprotectin and lactoferrin  and novel antibodies may help to increase the sensitivity and specificity in the non-invasive monitoring of IBD.
1. Vermeire S, Van Assche G, Rutgeerts P (2004), C‑reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis, 6615, 10(5).
2. Lewis JD (2011), The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology, 18171826, 140.