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P247. Evaluating small bowel disease activity in Crohn's disease: new evidence on the correlation between endoscopic scoring systems and CRP

F. Dias de Castro1, B. Rosa1, J. Magalhães1, M.J. Moreira1, J. Cotter1, 1Centro Hospitalar Alto Ave, Gastroenterology, Guimarães, Portugal

Background

Capsule endoscopy (CE) is a useful technology for the evaluation of small bowel diseases, including Crohn's disease (CD). New scores, such as Lewis Score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) have been developed to standardize the assessment of small bowel inflammation. Mucosal healing is an important end point in the management of CD. C reactive-protein (CRP) has been used as a biomarker of luminal inflammation and a predictor of the course of CD. Our aim was to assess the correlation between the two CE inflammation scoring systems and their association with CRP.

Methods

Retrospective single-center study, including 44 patients with isolated small-bowel CD, submitted to CE. CPR levels were assessed at the time of CE. LS and CECDAI were calculated by a single reviewer. Statistical correlation between the two endoscopic scores and CRP were calculated using Spearman test. Linear regression analysis was used to identify threshold levels for CECDAI.

Results

Forty four patients were included, 68% female with mean age 34±12 years. Small bowel examination was complete in 75% (n = 33) of patients, with a mean small bowel transit time of 355±126 min. In the majority (57%) of patients, CE diagnosed proximal small bowel involvement, revealing CD related lesions, out of the reach of the standard endoscope. At the time of CE, mean CRP level was 12.6±25.6 mg/dl. The mean LS was 1438±1742, range 112–6150 and the mean CECDAI was 7.2±5.7, range 1–22. In our cohort, CECDAI demonstrated a good correlation with CRP levels (rs = 0.487, p = 0.001), better than LS (rs = 0.372, p = 0.013). Strong correlation between LS and CECDAI was demonstrated (rs = 0.695, p < 0.01). Linear regression analysis demonstrated that LS thresholds of 135 and 790 correspond to CECDAI levels of 5 and 7, respectively. CECDAI ≥7 was significantly associated with the presence of higher levels of CRP (p < 0.05), while such association was not demonstrated for LS ≥790.

Conclusion

A strong correlation was observed between LS and CECDAI in the assessment of small bowel inflammatory activity. CECDAI thresholds of 5 and 7 corresponded to LS thresholds of 135 and 790, respectively. CECDAI correlated better than the LS with CRP levels. Prospective studies are needed to validate the use of these endoscopic scores in the follow-up of patients with isolated small-bowel CD, evaluating their potential role in monitoring the course of the disease and mucosal healing.