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P226 Does faecal Calprotectin help differentiate inflammatory from fibrous stenosis in Crohn’s disease?

Ben Farhat, F.(1);Sabbah, M.(2);Ben Abid, M.(3);Bibani, N.(1);Bellil, N.(1);Aoun, K.(4);Bouratbine, A.(5);Gargouri, D.(1);

(1)Habib Thameur Hospital, Department of Gastroenterology, Tunis, Tunisia;(2)Habib Thameur Hospital, Departement of Gastroenterology, Tunis, Tunisia;(3)Pasteur Institute of Tunis, Clinical Investigation center : Microbiota of human organism and health CIC 2017 HT 04, Tunis, Tunisia;(4)Pateur Institute of Tunis, Research Lab “Medical Parasitology- Biotechnology & Biomolecules” LR 20-IPT-06, Tunis, Tunisia;(5)Pasteur Institute of Tunis, Research Lab “Medical Parasitology- Biotechnology & Biomolecules” LR 20-IPT-06, Tunis, Tunisia

Background

Digestive stenosis is the most common complication of Crohn's disease. It can be either inflammatory or fibrous. The clinical, biological and especially morphological characteristics of the stenosis can help differentiate inflammatory stenosis from fibrous stenosis. The aim of our study was to evaluate the performance of fecal calprotectin (FC), a marker of intestinal inflammation, in identifying the type of stenosis.

Methods

A prospective study including all patients followed for Crohn's disease in the Gastroenterology Department of Habib Thameur Hospital over a 6-month period from July 2020 to December 2020 was performed. Clinical, biological, endoscopic and radiological data were collected. The inflammatory nature of the stenosis was mainly retained according to radiological activity signs objectified by cross-sectional imaging. All patients were given a FC assay at the time of inclusion. FC was dosed by using the Bulhmann® FCAL ELISA technique. The statistical study was carried out using the SPSS software version 22.0 (p value significant if lower than 0.05).

Results

Fifty patients were included in our study (mean age 40.54 years [18-67] and sex ratio (M/F) = 1.77). The average evolution time of the disease was 8 years [6 months- 27 years]. The disease was ileal in 16 patients, colic in 4 patients and ileocolic in 30. Twenty patients (40%) had an intestinal stenosis whose location was: ileocaecal anastomosis (n=9), ileal (n=8) and colic (n=3). Multiple stenoses (colic and ileal) were noted in 3 patients. Fifteen patients were on medical treatment at the time of inclusion: 7 patients were on Infliximab, 5 were on azathioprine and 3 were on 5ASA.  Digestive symptoms such as diarrhoea or subocclusive syndromes were noted in 7 patients. A biological inflammatory syndrome (CRP >10mg/L) was noted in 8 patients. Of the 20 stenoses included, 8 were of the inflammatory type (40%). In the presence of stenosis, the mean level of FC was 224.9 μg/g. A high level of FC was associated with the inflammatory type of stenosis (p<0.001). A cut-off of 135 µg/g had a sensitivity 100% and a specificity of 90%. CRP did not differentiate between inflammatory stenosis and fibrous stenosis (p=0.4).

Conclusion

According to our study, FC is a good marker of intestinal inflammation allowing to differentiate an inflammatory from a fibrous stenosis during Crohn's disease better than the usual biological markers. These results should be confirmed by larger studies.

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