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P298. Are serum biomarkers predictive of capsule enteroscopy positive findings in patients with suspected Crohn's disease?

P. Boal-Carvalho1, M. Barbosa1, B. Rosa1, M.-J. Moreira1, J. Cotter1, 1Centro Hospitalar Alto Ave, Gastrenterology, Guimarães, Portugal

Background

The small bowel may be involved in up to two thirds of patients with Crohn's disease (CD). The Lewis Score (LS) may be a useful tool to objectively assess capsule enteroscopy (CE) inflammatory activity. We aimed to identify the serum biomarkers potentially associated with the presence of CD lesions on CE. The secondary outcome was to evaluate the correlation of those biomarkers with the LS.

Methods

We retrospectively recruited 87 patients submitted to CE for suspected CD, between January 2007 and October 2012. Eighteen patients were excluded due to incomplete small bowel examination and/or missing data. CE was considered positive in the presence of small bowel erosions, ulcers and/or stenosis. The LS was calculated for every CE with positive findings. All patients were evaluated at the time of CE for a panel of serum biomarkers including hemoglobin level, white blood cell count, platelet count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Statistical analysis was performed by SPSS v. 17.0, using Independent Samples t-test and Spearman's Rho correlation.

Results

Eighty-seven patients were included, 54% women, with a mean age of 33 (16–79) years. CE revealed endoscopic findings compatible with small bowel CD in 39% of patients (n = 27). Patients with positive CE findings had a significantly higher level of ESR (23.7 vs. 13.8 mm/h, p = 0.039). Moreover, ESR and CRP positively correlated with the presence of CD lesions on CE (p = 0.008 and p = 0.004, respectively). No significant differences were observed regarding serum hemoglobin, (13.9 vs. 13.2 g/dL, p = ns) white blood cell count (7.3 vs. 7.9×109/L, p = ns) or platelet count (228 vs. 266×109/L, p = ns) in patients with or without positive findings on CE. None of the biomarkers was associated with the degree of inflammatory activity assessed by the LS.

Conclusion

In patients with suspected small bowel CD, a high level of serum ESR and/or CRP may be a surrogate marker of the presence of positive endoscopic findings on CE. Such biomarkers may be useful to optimize the selection of patients to undergo CE.