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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).

Statistical Values of ESR, CRP and Fe deficiency anaemia in UC patients
CRP & ESR75.9%90%93.2%67.5%

Colonic and terminal ileal biopsies from 98 colonoscopies in 62 different patients with known CD were analysed.

Statistical Values of ESR, CRP and IDA in CD patients
ESR & CRP70.9%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 [2] 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, 661–5, 10(5).

2. Lewis JD (2011), The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology, 1817–1826, 140.