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P007 Faecal protease activity as a predictor marker of disease recurrence in patients with Crohn's disease following ileocecectomy

R. Golovey*1,2, S. Hoffman1,2, E. Scapa2,3, N. Fliss4,3, H. Tulchinski2,6, I. Dotan2,7, N. Maharshak1,3,8,9

1Tel Aviv medical Center, The Research Center for Digestive Tract and Liver Diseases, Tel Aviv, Israel, 2Tel-Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel, 3Tel Aviv medical Center, Department of Gastroenterology and Liver Diseases, Tel Aviv, Israel, 4Tel Aviv medical Center, IBD center, Tel Aviv, Israel, 6Tel Aviv medical Center, Division of Surgery Colorectal Unit, Tel Aviv, Israel, 7Rabin Medical Center, Division of Gastroenterology, Petah Tikva, Israel, 8Tel Aviv Medical Center, IBD Center, Tel Aviv, Israel, 9Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel

Background

Up to 90% of Crohn's disease (CD) patients who undergo intestinal resection will suffer from endoscopic disease recurrence within 1 year. Some evidence suggests that increased intestinal permeability caused by disruption of the epithelial barrier may be the first step towards exposure of the immune system to enteric microbial antigens and to disease exacerbation. We examined whether increased faecal proteolytic activity predates endoscopic disease and whether it correlates with disease activity as reflected by faecal calprotectin level in CD patients post ileocecectomy resection.

Methods

CD patients who underwent ileocecectomy were prospectively recruited between 2010–2017 at the Tel Aviv Medical Center (TLVMC). Inclusion criteria were: clinical remission (CDAI <150) at 45 days post-surgery (Week 0), no residual disease and a non-sticturing-non-penetrating disease phenotype. Patients were evaluated at Weeks 0, 12, 24, 36, and 48 for faecal calprotectin level (CLP), faecal protease activity (PA) and disease activity was also assessed using the CDAI. Faecal PA was assessed using an FITC-casein florescence assay. All patients underwent scheduled colonoscopies at Weeks 24 and 48 to assess for disease recurrence. A Rutgeerts score of ≥i2 was considered as disease recurrence.

Results

Endoscopic evaluation of disease activity was documented in 33 patients at Week 24 and in 26 patients at Week 48 post screening. Thirteen patients had endoscopic recurrence at Week 24. Seven patients had endoscopic recurrence at Week 48. CLP levels at Week 12 were significantly higher in patients who suffered from disease recurrence at Week 24 (141.2 ± 147.4 vs. 398.0 ± 283.6, p = 0.032). CLP at Week 24 was significantly higher among patients with endoscopic disease recurrence at Week 48, compared with those who remained in remission (912.0 ± 1039.0 vs. 116.7 ± 84.8, p = 0.028). PA was not significantly higher in patients who suffered from endoscopic recurrence, was not elevated prior to disease recurrence and did not correlate with CLP levels at the various time points.

Conclusion

Faecal PA is not associated with CD activity in post-operative patients in contrast to faecal calprotectin level which is associated with post-operative CD recurrence and may be used to non-invasively monitor disease activity. Monitoring mucosal inflammation with better non-invasive techniques is crucial to limit disease progression and complications.