P366. Relevance of chromogranin A according to disease activity and medical treatment in IBD patients
S. Vradelis1, A. Zissimopoulos2, M. Konialis3, D. Chadolias4, A. Bampali4, T. Konstantinidis5, E. Efremidou6, G. Kouklakis4, 1Democritus University of Thrace, University Hospital of Alexandroupolis, 2nd Department of Internal Medicine, Alexandroupolis, Greece, 2Democritus University of Thrace, Nuclear Medicine Department, Alexandroupolis, Greece, 3Democritus University of Thrace, Molecular Biology School, Alexandroupolis, Greece, 4Democritus University of Thrace, University Hospital of Alexandroupolis, Endoscopy Unit, Alexandroupolis, Greece, 5Democritus University of Thrace, Public Health Laboratory, Alexandroupolis, Greece, 6Democritus University of Thrace, University Hospital of Alexandroupolis, First Surgical Department, Alexandroupolis, Greece
Chromogranin A (CgA) represents a well-known marker of neuroendocrine tumors in clinical practice. Apart from that it is elevated in various non-neoplastic diseases. The aim was to determine whether CgA correlates with disease activity in inflammatory bowel disease (IBD) and particularly in moderately active disease.
Patients with moderate ulcerative colitis (UC) or Crohn's disease (CD) were participated in this prospective study. They were treated either with biologics (infliximab or adalimumab) or conventional treatment (thiopurines or methotrexate and steroids) and classified according to their treatment in two groups. CgA was measured both at the index and follow up visit four weeks later.
Between January 2009 and June 2011, 56 adults with moderate IBD (UC, n = 29, CD, n = 27), 17 patients with irritable bowel syndrome and predominant diarrhea (IBS-D) and 40 healthy controls were recruited. IBS-D patients had a mean value of CgA 66.80±19.61, min 35.60 max 114.00 U/L. Healthy individuals had a mean value of CgA which was below 70 U/L. The serum CgA levels during the first measurement were significantly higher in IBD patients than in healthy controls or IBS-D patients. Furthermore, CD patients had a statistically significant higher value of CgA than UC patients (341.72±282.74 [SD], min 125.80, max 955.10 U/L and 179.17±92.47 [SD] U/L, min 68.00, max 350.00 U/L respectively, P < 0.01).
The biologics cohort included 24 IBD patients (UC, n = 15, CD, n = 9) and had a mean first value of CgA 169.16±59.58 [SD], min 88.00 and max 280.00 U/L. The second measurement on these patients had a mean value of 92.75±37.76 [SD], min 55.00 and max 195.00 U/L and they had a statistically significant reduction of the CgA value (P < 0.01). 18/24 (72%) patients were already in remission during the follow-up visit.
The conventional treatment cohort comprised 32 IBD patients (UC, n = 14, CD, n = 18). They had a mean first value of CgA 192.55±110.04 [SD], min 68.00 and max 350.00 U/L. The second measurement of CgA at these patients had a mean value of 266.68±151.90 [SD], min 85.00 and max 580.00 U/L. This was a statistically significant elevation of plasma CgA. (P < 0.01), although 22/32 (69%) patients were in remission during the follow-up visit.
CgA is significantly elevated in IBD patients with moderate activity than in healthy controls or IBS-D patients. Moreover, CD patients had significantly higher CgA levels than UC patients. CgA appears a reliable marker of disease activity in patients under biologics. Medical treatment and particularly steroids seem to interfere with CgA levels. IBS-D patients had normal CgA values.