1
|
Alexandersson BT, Andreasson A, Hedin C, Broms G, Schmidt PT, Forsberg A. Inflammatory Bowel Disease Is not Linked to a Higher Rate of Adverse Events in Colonoscopy-a Nationwide Population-based Study in Sweden. J Crohns Colitis 2023; 17:1962-1967. [PMID: 37402690 PMCID: PMC10798860 DOI: 10.1093/ecco-jcc/jjad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease may cause long-standing inflammation and fibrosis and may increase the risk of adverse events in colonoscopy. We evaluated whether inflammatory bowel disease and other potential risk factors are associated with bleeding or perforation in a nationwide, population-based, Swedish study. METHODS Data from 969 532 colonoscopies, including 164 012 [17%] on inflammatory bowel disease patients, between 2003 and 2019, were retrieved from the National Patient Registers. ICD-10 codes for bleeding [T810] and perforation [T812] within 30 days of the colonoscopy were recorded. Multivariable logistic regression was used to test if inflammatory bowel disease status, inpatient setting, time period, general anaesthesia, age, sex, endoscopic procedures, and antithrombotic treatment were associated with higher odds for bleeding and perforation. RESULTS Bleeding and perforation were reported in 0.19% and 0.11% of all colonoscopies, respectively. Bleeding [odds ratio 0.66, p <0.001] and perforation [odds ratio 0.79, p <0.033] were less likely in colonoscopies in individuals with inflammatory bowel disease status. Bleeding and perforation were more common in inpatient than in outpatient inflammatory bowel disease colonoscopies. The odds for bleeding but not perforation increased between 2003 to 2019. General anaesthesia was associated with double the odds for perforation. CONCLUSIONS Individuals with inflammatory bowel disease did not have more adverse events compared with individuals without inflammatory bowel disease status. However, the inpatient setting was associated with more adverse events, particularly in inflammatory bowel disease status. General anaesthesia was associated with a greater risk of perforation.
Collapse
Affiliation(s)
| | - Anna Andreasson
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
- School of Psychological Sciences Macquarie University, North Ryde, NSW 2109, Australia
| | - Charlotte Hedin
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
- Karolinska University Hospital, Department of Gastroenterology, Dermatovenerology and Rheumatology, Stockholm, Sweden
| | - Gabriella Broms
- Gastroenterology, Danderyd hospital, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Peter T Schmidt
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Forsberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Fenton D, Choi NK, Garcia NM, Dyer EC, Cohen NA, Rubin DT. Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project. CROHN'S & COLITIS 360 2022; 4:otac042. [PMID: 36778515 PMCID: PMC9802166 DOI: 10.1093/crocol/otac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 12/05/2022] Open
Abstract
Background Fecal calprotectin (Fcal) is a noninvasive, inexpensive biomarker of disease activity. However, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with noncompliance. Methods A retrospective chart review of patients with inflammatory bowel disease (IBD) who had a Fcal test ordered through our center between August 2021 and December 2021 was conducted. Demographic, clinical, disease, and test-related information were recorded. Patients with incomplete Fcal orders were sent a survey to better understand their reasons for noncompliance. Simple statistical analysis and and multivariable logistic regression modeling were performed. Results Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Remission of IBD, no prior Fcal completion, and tests ordered at a distant site were all associated with test noncompletion. A multivariable logistic regression revealed that history of a prior completed Fcal test is associated with subsequent test completion (odds ratio = 2.1, 95% confidence interval 1.9-35.5, P = .004). Patients who did not complete the test described the pandemic and third-party testing center issues as the most common reasons for noncompliance. Conclusions In this single center experience with Fcal testing in patients with IBD, we identified that a history of incomplete Fcal testing and distant location of lab testing were significantly associated with noncompletion of the test. We provide practical guidance for future utilization and compliance, including the impact of home-based testing.
Collapse
Affiliation(s)
- David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Natalie K Choi
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nicole M Garcia
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Emma C Dyer
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nathaniel A Cohen
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
3
|
Ishida N, Kaneko M, Asai Y, Miyazu T, Tamura S, Tani S, Yamade M, Iwaizumi M, Hamaya Y, Osawa S, Furuta T, Sugimoto K. Effect of disease duration on fecal biomarkers in ulcerative colitis: a prospective cohort study. BMC Gastroenterol 2022; 22:420. [PMID: 36109718 PMCID: PMC9476332 DOI: 10.1186/s12876-022-02502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biomarkers such as fecal calprotectin (FC) and fecal immunochemical occult blood tests (FIT) for ulcerative colitis (UC) are used in clinical practice. In this study, the effect of UC disease duration on FC was investigated and compared to that on FIT. METHODS One hundred twenty-eight colonoscopic examinations and two fecal biomarkers measurements were performed. The cases of UC were divided into short- and long-term disease-duration groups or categorized into three groups with disease durations of 0-5, 6-13, and 14-38 years. We analyzed correlations between biomarker levels and endoscopic scores, including the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity, and the sum of MES. RESULTS In the analysis of short- and long-term disease durations, the three endoscopic scores and biomarker levels showed significant correlations in both long-term and short-term groups. Most of the correlation coefficients for the individual long-term group were lower than the corresponding values for all cases, while most of the correlation coefficients for the individual short-term groups were higher than the corresponding values for all cases. In the three-group analysis (disease durations of 0-5, 6-13, and 14-38 years), the two biomarkers and three endoscopic scores showed significant correlations, and most of the correlation coefficients between biomarkers and endoscopic scores tended to be lower in the long-term follow-up group. In the receiver operating characteristic analysis for predicting mucosal healing in the three groups, the area under the curve for FC and FIT concentrations in the 0-5 year disease-duration group showed particularly higher values than those for the other two groups. CONCLUSIONS Similar to FIT, FC is affected by the duration of UC, indicating that FC may be a highly useful biomarker, especially in short-term disease.
Collapse
Affiliation(s)
- Natsuki Ishida
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Masanao Kaneko
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yusuke Asai
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takahiro Miyazu
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Satoshi Tamura
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shinya Tani
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mihoko Yamade
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Moriya Iwaizumi
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yasushi Hamaya
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| |
Collapse
|
4
|
C-reactive protein is superior to fecal biomarkers for evaluating colon-wide active inflammation in ulcerative colitis. Sci Rep 2021; 11:12431. [PMID: 34127687 PMCID: PMC8203605 DOI: 10.1038/s41598-021-90558-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
We evaluated the association between endoscopic scores of colonic inflammation and fecal calprotectin (FC), fecal immunochemical occult blood test (FIT), and C-reactive protein (CRP) in patients with ulcerative colitis (UC). Endoscopic scores reflecting the most severe lesion [maximum Mayo Endoscopic Subscore (M-MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS)] and those reflecting the inflammation of the entire colon [sum of MES (S-MES) and Ulcerative Colitis Colonoscopic Index of Severity (UCCIS)] were evaluated. FC, FIT, and CRP were measured, and their association with the four endoscopic scores was evaluated. Endoscopic scores of 78 complete colonoscopies (66 UC patients) were evaluated using the three biomarkers. FC and CRP tended to correlate more strongly with S-MES and UCCIS than with M-MES and UCEIS. In the M-MES 0, 1 group, compared to CRP, FC and FIT showed stronger correlations with S-MES and UCCIS. Conversely, in the M-MES 2, 3 group, only CRP was significantly correlated with each descriptor. CRP more strongly reflects colon-wide mucosal inflammation than FC and allows reliable assessment of inflammation throughout the colon in active UC.
Collapse
|
5
|
D'Amico F, Nancey S, Danese S, Peyrin-Biroulet L. A Practical Guide for Faecal Calprotectin Measurement: Myths and Realities. J Crohns Colitis 2021; 15:152-161. [PMID: 32392336 DOI: 10.1093/ecco-jcc/jjaa093] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Faecal calprotectin [FC] is a valid and non-invasive marker of mucosal inflammation. It is widely used both in clinical trials and in daily clinical practice for patients with inflammatory bowel diseases, but currently no accepted standardization for FC testing is available. Our primary aim here was to provide a clinician's guide containing all the practical information on FC measurement in order to avoid any confounding factors, to minimize intra- and inter-individual variability in dosage, and to ensure a better and adequate interpretation of the results. METHODS We conducted a detailed search of the scientific literature in the PubMed/MEDLINE, EMBASE and Cochrane databases up to January 2020 to find all relevant and available articles on pre-analytical and analytical phases of FC measurement. RESULTS FC testing is a multi-step procedure consisting of a pre-analytical phase aimed to collect and process the stool sample and a subsequent analytical phase of FC measurement. Several factors can influence test results determining false positives or false negatives. Importantly, this faecal marker is mostly used for patient follow-up and as a predictor of treatment response. For this reason, any altered data may affect the physicians' decisions, negatively impacting on patient management. CONCLUSIONS This review provides for the first time practical advice to minimize dosage variability, although further dedicated studies are needed to compare commercially available tests and identify the best tools for the most precise and accurate FC measurement.
Collapse
Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Stéphane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre Benite, and Inserm U1111, CIRI, Lyon, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano -IRCCS-, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
6
|
Messadeg L, Hordonneau C, Bouguen G, Goutorbe F, Reimund JM, Goutte M, Boucher AL, Scanzi J, Reymond M, Allimant C, Dapoigny M, Pereira B, Bommelaer G, Buisson A. Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy. J Crohns Colitis 2020; 14:1524-1534. [PMID: 32533769 DOI: 10.1093/ecco-jcc/jjaa098] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD]. AIMS We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage. METHODS All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52. RESULTS Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037). CONCLUSION Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.
Collapse
Affiliation(s)
- L Messadeg
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - C Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
| | - F Goutorbe
- Centre Hospitalier de la côte basque, Service d'Hépato-Gastro Entérologie, Bayonne, France
| | - J M Reimund
- Université de Strasbourg, INSERM UMR_1113 IRFAC, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Hépato-Gastro Entérologie et d'Assistance Nutritive, Strasbourg, France
| | - M Goutte
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A L Boucher
- CH Issoire, Service d'Hépato-Gastro Entérologie, Issoire, France
| | - J Scanzi
- CH Thiers, Service d'Hépato-Gastro Entérologie, Thiers, France
| | - M Reymond
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - C Allimant
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - M Dapoigny
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - B Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - G Bommelaer
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A Buisson
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| |
Collapse
|
7
|
Radiological Response Is Associated with Better Outcomes and Should Be Considered a Therapeutic Target in Crohn's Disease. Dig Dis Sci 2020; 65:2664-2674. [PMID: 31811438 DOI: 10.1007/s10620-019-05979-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of the study was to identify factors associated with a radiological response and to assess the impact of radiological improvement in long-term outcomes in small bowel (SB) Crohn's disease (CD) patients. METHODS We performed a retrospective study from June 2011 to June 2017 in the tertiary center, Claude Huriez Hospital in Lille, France. All SB CD patients, who underwent two magnetic resonance enterographies (MRE) 3-12 months apart, with at least 1-year follow-up after the second MRE, were included. Signs of radiological inflammation were identified by two expert radiologists in CD. Patients were classified as radiological responders (RR) and non-responders (NR). Hospitalization rates, adjustment of treatment, and surgical or endoscopic interventions were assessed and compared between RR and NR. Factors associated with a radiological response were also studied using the Cox model. RESULTS One hundred and fifteen SB CD patients were included with a median follow-up of 17 months (IQR 11.6-28.3). There were 54 (47%) RR and 61 (53%) NR. The risk of surgical or endoscopic intervention was higher in NR than RR (p = 0.04), and the median delay until a surgical or endoscopic intervention was shorter in NR (p = 0.04). Multifocal disease, a hypersignal on diffusion-weighted or dynamic contrast-enhanced imaging, a stricture, or a fistula was significantly associated with a decreased probability of a radiological response (p < 0.05). CONCLUSION This study shows that a radiological response is associated with a decreased risk of surgical or endoscopic intervention and should be considered as a therapeutic target in CD patients.
Collapse
|
8
|
D'Amico F, Bonovas S, Danese S, Peyrin-Biroulet L. Review article: faecal calprotectin and histologic remission in ulcerative colitis. Aliment Pharmacol Ther 2020; 51:689-698. [PMID: 32048751 DOI: 10.1111/apt.15662] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Histologic healing is emerging as a new therapeutic goal in both routine practice and clinical trials in ulcerative colitis (UC). However, it requires repeated endoscopies and biopsies. Faecal calprotectin is a non-invasive marker of mucosal healing (endoscopic and histologic healing). AIM To conduct a systematic review to clarify the correlation between faecal calprotectin levels and histologic activity in UC patients. METHODS We searched PubMed/MEDLINE, EMBASE and Web of Science through September 2019 to identify studies in patients with confirmed diagnosis of UC, reporting the correlation between faecal calprotectin levels and histologic analysis. RESULTS Twelve studies enrolling 1168 patients were included in the final review. Histologic remission was defined according to nonvalidated scores in five articles and using partially validated scores in seven articles. Faecal calprotectin values were measured in 6 of 12 studies (50%) with the same kit, while the remaining six studies adopted individually different kits. A clear correlation between faecal calprotectin levels and histology was showed in all included studies. Eleven different faecal calprotectin cut-off points were identified to distinguish histological remission from histological activity, ranging from 40.5 to 250 μg/g. CONCLUSIONS Faecal calprotectin can be used to predict histologic remission in patients with UC, but the cut-off level varies across studies, according to the test used to measure this biomarker and according to the definition of histologic remission. Larger prospective studies using validated histologic indexes are needed to identify a globally accepted faecal calprotectin cut-off level to discriminate between histologic remission and histologically active disease.
Collapse
Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
9
|
Briot C, Faure P, Parmentier AL, Nachury M, Trang C, Viennot S, Altwegg R, Bulois P, Thomassin L, Serrero M, Ah-Soune P, Gilletta C, Plastaras L, Simon M, Dray X, Caillo L, Del Tedesco E, Abitbol V, Zallot C, Degand T, Rossi V, Bonnaud G, Colin D, Morel B, Winkfield B, Danset JB, Filippi J, Amiot A, Attar A, Levy J, Peyrin-Biroulet L, Vuitton L. Efficacy, Tolerability, and Safety of Low-Volume Bowel Preparations for Patients with Inflammatory Bowel Diseases: The French Multicentre CLEAN Study. J Crohns Colitis 2019; 13:1121-1130. [PMID: 30785181 DOI: 10.1093/ecco-jcc/jjz040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
Collapse
Affiliation(s)
- C Briot
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - P Faure
- Department of Gastroenterology, Clinique Pasteur, Toulouse, France
| | - A L Parmentier
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Gastroenterology Department, University Hospital of Lille, Lille, France
| | - C Trang
- Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France
| | - S Viennot
- Gastroenterology Department, University Hospital of Caen, Caen, France
| | - R Altwegg
- Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France
| | - P Bulois
- Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France
| | - L Thomassin
- Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France
| | - M Serrero
- Department of Gastroenterology, APHM, Hopital Nord, Marseille, France
| | - P Ah-Soune
- Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France
| | - C Gilletta
- Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France
| | - L Plastaras
- Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - X Dray
- Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France
| | - L Caillo
- Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - V Abitbol
- Department of Gastroenterology, University Hospital Cochin, Paris, France
| | - C Zallot
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - T Degand
- Department of Gastroenterology, University Hospital Le Bocage, Dijon, France
| | - V Rossi
- Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France
| | - G Bonnaud
- Clinique Ambroise Paré, Toulouse, France
| | - D Colin
- Department of Gastroenterology, Clinique de la Miotte, Belfort, France
| | - B Morel
- Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France
| | - B Winkfield
- Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France
| | - J B Danset
- Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France
| | - J Filippi
- Department of Gastroenterology, University Hospital L'Archet, Nice, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - A Attar
- Gastroenterology Department, Beaujon University Hospital, Clichy, France
| | - J Levy
- Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - L Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | | |
Collapse
|
10
|
Sollelis E, Quinard RM, Bouguen G, Goutte M, Goutorbe F, Bouvier D, Pereira B, Bommelaer G, Buisson A. Combined evaluation of biomarkers as predictor of maintained remission in Crohn’s disease. World J Gastroenterol 2019; 25:2354-2364. [PMID: 31148906 PMCID: PMC6529885 DOI: 10.3748/wjg.v25.i19.2354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The individual performances and the complementarity of Crohn’s disease (CD) activity index (CDAI), C-reactive protein (CRP) and faecal calprotectin (Fcal) to monitor patients with CD remain poorly investigated in the era of “tight control” and “treat to target” strategies.
AIM To assess CDAI, CRP and Fcal variation, alone or combined, after 12 wk (W12) of anti-tumor necrosis factor (TNF) therapy to predict corticosteroids-free remission (CFREM = CDAI < 150, CRP < 2.9 mg/L and Fcal < 250 μg/g with no therapeutic intensification and no surgery) at W52.
METHODS CD adult patients needing anti-TNF therapy with CDAI > 150 and either CRP > 2.9 mg/L or Fcal > 250 μg/g were prospectively enrolled.
RESULTS Among the 40 included patients, 13 patients (32.5%) achieved CFREM at W52. In univariable analysis, CDAI < 150 at W12 (P = 0.012), CRP level < 2.9 mg/L at W12 (P = 0.001) and Fcal improvement at W12 (Fcal < 300 μg/g; or, for patients with initial Fcal < 300 μg/g, at least 50% decrease of Fcal or normalization of Fcal (< 100 μg/g) (P = 0.001) were predictive of CFREM at W52. Combined endpoint (CDAI < 150 and CRP ≤ 2.9 mg/L and FCal improvement) at W12 was the best predictor of CFREM at W52 with positive predictive value = 100.0% (100.0-100.0) and negative predictive value = 87.1% (75.3-98.9). In multivariable analysis, Fcal improvement at W12 [odd ratio (OR) = 45.1 (2.96-687.9); P = 0.03] was a better predictor of CFREM at W52 than CDAI < 150 [OR = 9.3 (0.36-237.1); P = 0.145] and CRP < 2.9 mg/L (0.77-278.0; P = 0.073).
CONCLUSION The combined monitoring of CDAI, CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.
Collapse
Affiliation(s)
- Elisa Sollelis
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| | - Régine Minet Quinard
- Biochemistry laboratory, University Hospital G. Montpied, Clermont-Ferrand F-63000, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes F-35000, France
| | - Marion Goutte
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| | - Félix Goutorbe
- Gastroenterology Department, Hospital of Bayonne, Bayonne F-64100, France
| | - Damien Bouvier
- Biochemistry laboratory, University Hospital G. Montpied, Clermont-Ferrand F-63000, France
| | - Bruno Pereira
- Biostatistics Unit, DRCI, University Hospital, Clermont-Ferrand F-63000, France
| | - Gilles Bommelaer
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| | - Anthony Buisson
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| |
Collapse
|
11
|
Bowel wall healing assessed using magnetic resonance imaging predicts sustained clinical remission and decreased risk of surgery in Crohn's disease. J Gastroenterol 2019; 54:312-320. [PMID: 30167884 DOI: 10.1007/s00535-018-1505-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic mucosal healing is considered as the best therapeutic target in Crohn's disease (CD) as it is associated with better long-term outcomes. We investigated whether bowel wall healing (BWH) assessed using magnetic resonance imaging (MRI) could predict favorable outcomes and could be a potential therapeutic target. METHODS We performed a post hoc analysis from two prospective studies (n = 174 patients). All the patients with previous objective signs of bowel inflammation and assessed by MRI for therapeutic efficacy had a standardized and blinded evaluation, and underwent MRI. Complete BWH was defined as no segmental MaRIA > 7 or no segmental Clermont score > 8.4 and BWH as no segmental MaRIA > 11 or no segmental Clermont score > 12.5. Clinical corticosteroid-free remission (CFREM) was defined as no reappearance or worsening of clinical manifestation leading to therapeutic modification, hospitalization or CD-related surgery. Multivariate analyses were performed including all the relevant parameters. RESULTS Overall, 63 patients with CD were included (mean follow-up = 4.8 ± 3.1 semesters). In multivariate analysis (n = 303 semesters), complete BWH or BWH was associated with sustained CFREM according to MaRIA [OR = 4.42 (2.29-26.54); p = 0.042 and OR = 3.43 (1.02-27.02); p = 0.047, respectively] or Clermont score [OR = 3.09 (1.01-12.91); p = 0.049 and OR = 3.88 (1.40-13.80); p = 0.036, respectively]. In multivariate analysis (n = 63 patients), complete BWH or BWH was associated with decreased risk of surgery using MaRIA [HR = 0.16 (0.043-0.63); p = 0.008 and HR = 0.24 (0.07-0.77); p = 0.017, respectively] or Clermont score [HR = 0.24 (0.07-0.78); p = 0.016 and HR = 0.23 (0.07-0.76); p = 0.016, respectively]. CONCLUSIONS MRI endpoints are predictive of favorable outcomes after medical therapy and could be used as therapeutic target in daily practice and clinical trials.
Collapse
|
12
|
Fecal calprotectin is significantly linked to azathioprine metabolite concentrations in Crohn's disease. Eur J Gastroenterol Hepatol 2019; 31:99-108. [PMID: 30212402 DOI: 10.1097/meg.0000000000001262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The value of therapeutic drug monitoring during azathioprine (AZA) therapy with respect to clinical outcomes has been convincingly demonstrated in recent meta-analyses. However, the association between AZA metabolites and the mucosal state in inflammatory bowel disease is largely unclear. AIMS We investigated the association between AZA's active metabolite 6-thioguanine nucleotides (6-TGN) and fecal calprotectin (FC) as a well-validated surrogate marker of mucosal inflammation in patients with Crohn's disease (CD) on AZA monotherapy. PATIENTS AND METHODS Of 443 6-TGN measurements, 140 values from 88 patients with CD on AZA monotherapy visiting the inflammatory bowel disease outpatient clinic between 2009 and 2016 were retrospectively analyzed. In a subcohort with serial 6-TGN measurements, longitudinal FC measurements in patients with versus without intervention (dose increase, allopurinol, and education) were assessed. RESULTS In patients with 6-TGN concentrations within a predefined range (250-450 pmol/8×10 red blood cells), FC was significantly lower (median: 119.5 vs. 327.2 mg/kg, P=0.003), and hemoglobin as well as serum protein concentrations were significantly higher than in patients with 6-TGN outside of this range. C-reactive protein and transferrin saturation were not different. In the longitudinal cohort, 6-TGN increased in the intervention group, but only a minority reached the defined range; no significant change in FC was observed. CONCLUSION This study is the first to show that in patients with CD receiving AZA monotherapy, 6-TGN concentrations within a defined range (250-450 pmol/8×10 red blood cells) are associated with significantly lower FC. A treat-to-target concept directed by 6-TGN to reach mucosal healing may thus be a promising approach (DRKS00013246).
Collapse
|
13
|
Thierry ML, Rousseau H, Pouillon L, Girard-Gavanier M, Baumann C, Lopez A, Danese S, Laurent V, Peyrin-Biroulet L. Accuracy of Diffusion-weighted Magnetic Resonance Imaging in Detecting Mucosal Healing and Treatment Response, and in Predicting Surgery, in Crohn's Disease. J Crohns Colitis 2018; 12:1180-1190. [PMID: 29985999 DOI: 10.1093/ecco-jcc/jjy098] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS The Nancy score is a luminal Crohn's disease [CD] activity index applied in diffusion-weighted magnetic resonance imaging [DW-MRI]. We assessed the accuracy of the Nancy score in detecting mucosal healing and treatment response, and in predicting surgery. METHODS This was a retrospective, single-centre study of all patients with active CD and serial DW-MRI before and after treatment initiation with a biologic drug, between January 2010 and September 2016. The gold standard was endoscopy. The association between the Nancy score and the cumulative probability of intestinal resection during follow-up was tested combining Kaplan-Meier curves and log-rank testing. RESULTS A total of 96 patients were included; 20 had concomitantly undergone endoscopy. The Nancy score correlated well with the Crohn's Disease Endoscopic Index of Severity [r = 0.60 for the total score and r = 0.63 for the segmental score]. A total Nancy score <6 and a segmental Nancy score <2 detected mucosal healing with an area under the receiver operating characteristic curve [AUROC] of 0.82 (95% confidence interval [CI] 0.69-0.94, p <0.0001) and 0.80 [95% CI 0.73-0.87, p <0.0001], respectively. The Nancy score was highly sensitive to changes [Guyatt's responsiveness indices: 1.18 for the total score and 0.85 for the segmental score]. Mucosal healing on DW-MRI after treatment initiation was associated with a lower cumulative probability of intestinal surgery (p = 0.0251, median [interquartile range: IQR] follow-up 2.2 [1.6-3.7] years). CONCLUSIONS In CD, the Nancy score accurately detects mucosal healing and treatment response, the latter associated with a lower likelihood of intestinal resection.
Collapse
Affiliation(s)
- Marie-Lise Thierry
- INSERM U954 and Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Hélène Rousseau
- Clinical Research Support Facility PARC, UMDS, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Lieven Pouillon
- INSERM U954 and Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | - Mélanie Girard-Gavanier
- INSERM U947 and Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Cédric Baumann
- Clinical Research Support Facility PARC, UMDS, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Anthony Lopez
- INSERM U954 and Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Valérie Laurent
- INSERM U947 and Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
14
|
Fecal Matrix Metalloprotease-9 and Lipocalin-2 as Biomarkers in Detecting Endoscopic Activity in Patients With Inflammatory Bowel Diseases. J Clin Gastroenterol 2018; 52:e53-e62. [PMID: 28723856 DOI: 10.1097/mcg.0000000000000837] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fecal biomarkers are emerging tools in the assessment of mucosal healing in inflammatory bowel diseases (IBD). GOALS We aimed to evaluate the accuracy of fecal matrix metalloprotease-9 (MMP-9) and fecal lipocalin-2 (LCN-2) compared with calprotectin in detecting endoscopic activity in IBD STUDY:: Overall, 86 IBD adults underwent colonoscopy consecutively and prospectively, with Crohn's disease Endoscopic Index of Severity (CDEIS) in Crohn's disease (CD) patients or Mayo endoscopic subscore calculation for ulcerative colitis (UC) patients, and stool collection. Fecal calprotectin was measured using quantitative immunochromatographic testing. Fecal MMP-9 and LCN-2 was quantified by enzyme-linked immunosorbent assay. MMP-9 and LCN-2 thresholds were determined using receiver operating curves. RESULTS In 54 CD patients, fecal calprotectin, MMP-9 and LCN-2 correlated with CDEIS and were significantly increased in patients with endoscopic ulcerations. MMP-9 >350 ng/g detected endoscopic ulceration in CD with a sensitivity of 90.0% and a specificity of 63.6%, compared with fecal calprotectin >250 μg/g (sensitivity=90.5% and specificity=59.1%). Fecal LCN-2 demonstrated lower performances than the 2 other biomarkers (sensitivity=85.7% and specificity=45.5%).In 32 UC patients, fecal MMP-9, LCN-2, and calprotectin levels were significantly increased in patients with endoscopic activity. In UC patients, fecal MMP-9 >900 ng/g had the best efficacy to detect endoscopic activity (sensitivity=91.0% and specificity=80.0%, compared with fecal calprotectin >250 μg/g (sensitivity=86.4% and specificity=80.0%) and LCN-2 >6700 ng/g (sensitivity=82.0% and specificity=80.0%). CONCLUSIONS Fecal MMP-9 is a reliable biomarker in detecting endoscopic activity in both UC and CD patients.
Collapse
|
15
|
Baillet P, Cadiot G, Goutte M, Goutorbe F, Brixi H, Hoeffel C, Allimant C, Reymond M, Obritin-Guilhen H, Magnin B, Bommelaer G, Pereira B, Hordonneau C, Buisson A. Faecal calprotectin and magnetic resonance imaging in detecting Crohn’s disease endoscopic postoperative recurrence. World J Gastroenterol 2018; 24:641-650. [PMID: 29434453 PMCID: PMC5799865 DOI: 10.3748/wjg.v24.i5.641] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess magnetic resonance imaging (MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn’s disease (CD).
METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo (5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence (POR) was defined as Rutgeerts’ index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.
RESULTS Apparent diffusion coefficient (ADC) was lower in patients with endoscopic POR compared to those with no recurrence (2.03 ± 0.32 vs 2.27 ± 0.38 × 10-3 mm²/s, P = 0.032). Clermont score (10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement (RCE) (129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity (MaRIA) (7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system (P = 0.056). ADC < 2.35 × 10-3 mm²/s [sensitivity = 0.85, specificity = 0.65, positive predictive value (PPV) = 0.85, negative predictive value (NPV) = 0.65] and RCE > 100% (sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cut-off values to identify endoscopic POR. Clermont score > 6.4 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), MaRIA > 3.76 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1 (sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR (114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR (sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).
CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.
Collapse
Affiliation(s)
- Pierre Baillet
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
| | - Guillaume Cadiot
- CHU de Reims, Service d’Hépato-Gastro Entérologie, Reims 51100, France
| | - Marion Goutte
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
| | - Felix Goutorbe
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- CH de Bayonne, Service d’Hépato-Gastro Entérologie, Bayonne 64100, France
| | - Hedia Brixi
- CHU de Reims, Service d’Hépato-Gastro Entérologie, Reims 51100, France
| | | | - Christophe Allimant
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
| | - Maud Reymond
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
| | - Hélène Obritin-Guilhen
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
| | - Benoit Magnin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
| | - Gilles Bommelaer
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand 63000, France
| | - Constance Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
| |
Collapse
|
16
|
Comparative Acceptability and Perceived Clinical Utility of Monitoring Tools: A Nationwide Survey of Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:1425-1433. [PMID: 28570431 DOI: 10.1097/mib.0000000000001140] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Objective control of intestinal inflammation during inflammatory bowel disease (IBD) is becoming the main driver for medical treatment. However, the monitoring tools-related burden remains poorly investigated. We aimed to evaluate their comparative acceptability and utility according to patients with IBD. METHODS After a preliminary phase, the final questionnaire encompassing self-administered and physician questionnaires was prospectively and consecutively submitted to 916 patients with IBD from 20 public and private centers. Acceptability and utility visual analog scales (VAS) were expressed as median with interquartile range. RESULTS Regarding the group of patients with Crohn's disease (n = 618), venipuncture (VAS = 9.3 [8.8-9.7]) and ultrasonography (VAS = 9.3 [8.7-9.7]) were the most acceptable tools (P < 0.0001, for each comparison), whereas rectosigmoidoscopy was the least acceptable tool (VAS = 4.4 [1.2-7.3]) (P < 0.0001, for each comparison). Wireless capsule endoscopy (VAS = 8.5 [5.2-9.3]), magnetic resonance enterocolonography (VAS = 8.0 [5.0-9.2]), and stools collection (VAS = 7.7 [4.6-9.3]) were more acceptable than colonoscopy (VAS = 6.7 [4.3-8.9]) (P < 0.0001, for each comparison). The acceptability was assessed in 298 patients with ulcerative colitis for venipuncture (VAS = 9.4 [8.8-9.7]), stools collection (VAS = 8.1 [5.7-9.4]), colonoscopy (VAS = 7.5 [4.7-9.2]), and rectosigmoidoscopy (VAS = 6.7 [2.8-9.1]); (P < 0.001 for each comparison). All monitoring tools were considered as highly useful by patients with IBD. Decreased acceptability was related to embarrassment for the collection/transport of stools (60.7%), bowel cleansing (76.3%) for colonoscopy, abdominal discomfort (51.3%) and rectal enema (36.6%) for rectosigmoidoscopy, bowel distension (48.3%) for magnetic resonance enterocolonography, and potential capsule retention (21.4%) for wireless capsule endoscopy. CONCLUSIONS Among the IBD monitoring tools, endoscopy demonstrated the lowest acceptability supporting the development of alternative modalities. Patients' information and examination conditions should be improved to ensure proper monitoring adherence.
Collapse
|
17
|
Brückner M, Heidemann J, Nowacki TM, Cordes F, Stypmann J, Lenz P, Gohar F, Lügering A, Bettenworth D. Detection and characterization of murine colitis and carcinogenesis by molecularly targeted contrast-enhanced ultrasound. World J Gastroenterol 2017; 23:2899-2911. [PMID: 28522908 PMCID: PMC5413785 DOI: 10.3748/wjg.v23.i16.2899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/14/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To study mucosal addressin cellular adhesion molecule-1 (MAdCAM-1) and vascular endothelial growth factor (VEGF)-targeted contrast enhanced ultrasound (CEUS) for the assessment of murine colitis and carcinogenesis.
METHODS C57BL/6 mice were challenged with 3% dextran sodium-sulfate (DSS) for three, six or nine days to study the development of acute colitis. Ultrasound was performed with and without the addition of unspecific contrast agents. MAdCAM-1-targeted contrast agent was used to detect and quantify MAdCAM-1 expression. Inflammatory driven colorectal azoxymethane (AOM)/DSS-induced carcinogenesis was examined on day 42 and 84 using VEGF-targeted contrast agent. Highly specific tissue echogenicity was quantified using specialized software. Sonographic findings were correlated to tissue staining, western blot analysis and immunohistochemistry to quantify the degree of inflammation and stage of carcinogenesis.
RESULTS Native ultrasound detected increased general bowel wall thickening that correlated with more progressed and more severe DSS-colitis (healthy mice: 0.3 mm ± 0.03 vs six days DSS: 0.5 mm ± 0.2 vs nine days DSS: 0.6 mm ± 0.2, P < 0.05). Moreover, these sonographic findings correlated well with clinical parameters such as weight loss (r2 = 0.74) and histological damage (r2 = 0.86) (P < 0.01). In acute DSS-induced murine colitis, CEUS targeted against MAdCAM-1 detected and differentiated stages of mild, moderate and severe colitis via calculation of mean pixel contrast intensity in decibel (9.6 dB ± 1.6 vs 12.9 dB ± 1.4 vs 18 dB ± 3.33, P < 0.05). Employing the AOM/DSS-induced carcinogenesis model, tumor development was monitored by CEUS targeted against VEGF and detected a significantly increased echogenicity in tumors as compared to adjacent healthy mucosa (healthy mucosa, 1.6 dB ± 1.4 vs 42 d, 18.2 dB ± 3.3 vs 84 d, 18.6 dB ± 4.9, P < 0.01). Tissue echogenicity strongly correlated with histological analysis and immunohistochemistry findings (VEGF-positive cells in 10 high power fields of healthy mucosa: 1 ± 1.2 vs 42 d after DSS start: 2.4 ± 1.6 vs 84 d after DSS start: 3.5 ± 1.3, P < 0.01).
CONCLUSION Molecularly targeted CEUS is a highly specific and non-invasive imaging modality, which characterizes murine intestinal inflammation and carcinogenesis in vivo.
Collapse
|
18
|
Yamamoto-Furusho J, Bosques-Padilla F, de-Paula J, Galiano M, Ibañez P, Juliao F, Kotze P, Rocha J, Steinwurz F, Veitia G, Zaltman C. Diagnosis and treatment of inflammatory bowel disease: First Latin American Consensus of the Pan American Crohn's and Colitis Organisation. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
19
|
Yamamoto-Furusho J, Bosques-Padilla F, de-Paula J, Galiano M, Ibañez P, Juliao F, Kotze P, Rocha J, Steinwurz F, Veitia G, Zaltman C. Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:46-84. [PMID: 27979414 DOI: 10.1016/j.rgmx.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/23/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023]
|
20
|
Sozutek A, Ozyazici S, Colak T, Cetınkunar S, Irkorucu O, Bobusoglu O, Cennet A. Evaluating the effect of infliximab on the healing of left colonic anastomosis in the presence of intra-abdominal sepsis. Arab J Gastroenterol 2016; 17:84-9. [DOI: 10.1016/j.ajg.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
|
21
|
Stoppino LP, Della Valle N, Rizzi S, Cleopazzo E, Centola A, Iamele D, Bristogiannis C, Stoppino G, Vinci R, Macarini L. Magnetic resonance enterography changes after antibody to tumor necrosis factor (anti-TNF) alpha therapy in Crohn's disease: correlation with SES-CD and clinical-biological markers. BMC Med Imaging 2016; 16:37. [PMID: 27149857 PMCID: PMC4857261 DOI: 10.1186/s12880-016-0139-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/28/2016] [Indexed: 12/25/2022] Open
Abstract
Background In recent years, the use of MRI in patients with Crohn’s disease (CD) has increased. However, few data are available on how MRI parameters of active disease change during treatment with anti-TNF and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. The aim of this study was to determine the changes over time in MRI parameters during treatment with anti-TNF in patients with CD, and to verify the correlation between MRI score, endoscopic appearance and clinical-biological markers. Methods We performed a prospective single centre study of 27 patients with active CD (18 males and 9 females; median age of 27,4 ys; age range, 19–49). All patients underwent ileocolonoscopy and MRI at baseline and 26 weeks after anti-TNF therapy. Endoscopic severity was graded according to the Simple Endoscopic Score for Crohn’s Disease (SES-CD) and Magnetic Resonance Index of Activity (MaRIA) was calculated. Patients underwent clinical evaluation (CDAI) and the C-reactive protein (CRP) level was measured. The associations between variables were assessed with Pearson’s bivariate correlation analysis. Results A total of 135 intestinal segments were studied. The median patient age was 27,4 years, 67 % were male and the mean disease duration was 6,1 years. For induction of remission, 18 patients were treated with infliximab and 9 with adalimumab. The mean SES-CD and MaRIA scores significantly changed at week 26 (SES-CD: 14,7 ± 8,9 at baseline vs. 4,4 ± 4,6 at 26 weeks - p < 0.001; MaRIA: 41,1 ± 14,8 at baseline vs. 32,8 ± 11,7 at 26 weeks - p < 0.001). Also the CDAI and serum levels of CRP decreased significantly following treatment (p < 0.001). The overall MaRIA correlated with endoscopic score and with clinical activity (CDAI) both at baseline and at week 26 (p < 0.05). The correlation between overall MaRIA and CRP was significant only at week 26 (p < 0.001). Conclusions The MaRIA has a good correlation with SES-CD, a high accuracy for prediction of endoscopic mucosal healing and is a reliable indicator to monitor the use of TNF antagonists in patients with CD.
Collapse
Affiliation(s)
- Luca Pio Stoppino
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy.
| | - Nicola Della Valle
- Division of Gastroenterology, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Stefania Rizzi
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Elsa Cleopazzo
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Annarita Centola
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Donatello Iamele
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Christos Bristogiannis
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Giuseppe Stoppino
- Division of Gastroenterology, Department of Surgical Sciences, Azienda Sanitaria Locale Provincia di Foggia, Piazza della Libertà n.1, Foggia, 71122, Italy
| | - Roberta Vinci
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| | - Luca Macarini
- Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy
| |
Collapse
|
22
|
Buisson A, Vazeille E, Minet-Quinard R, Goutte M, Bouvier D, Goutorbe F, Pereira B, Barnich N, Bommelaer G. Faecal chitinase 3-like 1 is a reliable marker as accurate as faecal calprotectin in detecting endoscopic activity in adult patients with inflammatory bowel diseases. Aliment Pharmacol Ther 2016; 43:1069-79. [PMID: 26953251 DOI: 10.1111/apt.13585] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/22/2015] [Accepted: 02/18/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Faecal biomarkers are emerging tools in the assessment of mucosal healing in inflammatory bowel diseases (IBDs). AIM To evaluate the accuracy of faecal chitinase 3-like 1(CHI3L1) compared to calprotectin in detecting endoscopic activity in IBD. METHODS Overall, 86 IBD adults underwent colonoscopy consecutively and prospectively, with Crohn's disease Endoscopic Index of Severity (CDEIS) or Mayo endoscopic subscore calculation for ulcerative colitis, and stool collection. Faecal calprotectin was measured using quantitative immunochromatographic testing. Faecal CHI3L1 was quantified by ELISA. CHI3L1 cut-off value was determined using a receiver-operating curve. RESULTS In 54 Crohn's disease patients, faecal CHI3L1 (ρ = 0.70, P < 0.001) and calprotectin (ρ = 0.74, P < 0.001) levels correlated with CDEIS and were significantly increased in patients with endoscopic ulceration. In patients with ileal Crohn's disease, faecal CHI3L1 seemed to be better correlated with CDEIS than faecal calprotectin (ρ = 0.78 vs. ρ = 0.62, P < 0.001 for both). CHI3L1 > 15 ng/g detected endoscopic ulceration in Crohn's disease with a sensitivity of 100% and a specificity of 63.6%, compared to faecal calprotectin > 250 μg/g showing a sensitivity of 90.5% and a specificity of 59.1%. In 32 ulcerative colitis patients, faecal CHI3L1 and calprotectin levels correlated with Mayo endoscopic subscore (ρ = 0.44 and 0.61, respectively, P < 0.001 for both) and were significantly increased in ulcerative colitis patients with endoscopic activity. In ulcerative colitis patients, faecal CHI3L1 > 15 ng/g predicted endoscopic activity with a sensitivity of 81.8% and a specificity of 80.0%, compared to faecal calprotectin>250 μg/g showing a sensitivity of 86.4% and a specificity of 80.0%. CONCLUSION Faecal CHI3L1 is a reliable biomarker in detecting endoscopic activity in IBD.
Collapse
Affiliation(s)
- A Buisson
- Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France.,Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France
| | - E Vazeille
- Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France.,Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France
| | - R Minet-Quinard
- Biochemistry Laboratory, University Hospital G. Montpied, Clermont-Ferrand, France
| | - M Goutte
- Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France.,Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France
| | - D Bouvier
- Biochemistry Laboratory, University Hospital G. Montpied, Clermont-Ferrand, France
| | - F Goutorbe
- Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit- DRCI, GM - Clermont-Ferrand University and Medical Center, Clermont-Ferrand, France
| | - N Barnich
- Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France
| | - G Bommelaer
- Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France.,Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France
| |
Collapse
|
23
|
Goutorbe F, Goutte M, Minet-Quinard R, Boucher AL, Pereira B, Bommelaer G, Buisson A. Endoscopic Factors Influencing Fecal Calprotectin Value in Crohn's Disease. J Crohns Colitis 2015; 9:1113-9. [PMID: 26351383 DOI: 10.1093/ecco-jcc/jjv150] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Fecal calprotectin [fcal] is a biomarker of Crohn's disease [CD] endoscopic activity. Identifying the endoscopic situations in which fcal is less reliable remains unexplored. We aimed to determine the endoscopic factors influencing fcal level in CD. METHODS Overall, 53 CD patients consecutively and prospectively underwent colonoscopy, with CD Endoscopic Index of Severity [CDEIS] calculation and stool collection. Fcal was measured using a quantitative immunochromatographic test. Correlation analysis was done with Pearson statistics. RESULTS Fcal was correlated with CDEIS [0.66, p < 0.001]. In univariate analysis, fcal was correlated with the affected surface [0.65, p < 0.001] and the ulcerated surface [0.47, p < 0.001]. Fcal was significantly associated with ulceration depth, with median fcal of 867.5 µg/g, 1251.0 µg/g, and 1800.0 µg/g, in patients presenting with non-ulcerated lesions, superficial ulcerations [SU], and deep ulcerations [DU], respectively. Lesion locations did not influence fcal. In multivariate analysis, fcal was associated with affected surface [p = 0.04] and the presence of CD lesions. Moreover, fcal increased with the ulceration depth [p = 0.03]. However, ulcerated surface and CD location did not affect fcal. Using a receiver operating characteristic [ROC] curve, we showed that fcal of 400 µg/g was the best compromise between sensitivity [0.76] and specificity [0.77], whereas fcal ≥ 200 µg/g was highly sensitive [0.86] to detect SU or DU. CONCLUSIONS Fcal is a very reliable biomarker to detect endoscopic ulcerations in CD. We suggest repeating measurement in case of intermediary results [200-400 µg/g] in daily practice. Fcal level is mostly influenced by the presence of CD lesions [even non-ulcerated], in a depth-related manner and by the affected surface.
Collapse
Affiliation(s)
- F Goutorbe
- University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France
| | - M Goutte
- University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France UMR 1071 Inserm/Universite d'Auvergne; USC-INRA 2018, Clermont-Ferrand, France
| | - R Minet-Quinard
- GM Clermont-Ferrand University and Medical Center, Biochemistry Unit, Clermont- Ferrand, France
| | - A-L Boucher
- University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France
| | - B Pereira
- GM Clermont-Ferrand University and Medical Center, DRCI, Biostatistics Unit, Clermont-Ferrand, France
| | - G Bommelaer
- University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France UMR 1071 Inserm/Universite d'Auvergne; USC-INRA 2018, Clermont-Ferrand, France
| | - A Buisson
- University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France UMR 1071 Inserm/Universite d'Auvergne; USC-INRA 2018, Clermont-Ferrand, France
| |
Collapse
|
24
|
Ogawa T, Ohda Y, Nagase K, Kono T, Tozawa K, Tomita T, Iimuro M, Hida N, Oshima T, Fukui H, Hori K, Watari J, Nakamura S, Miwa H. Evaluation of discomfort during colonoscopy with conventional and ultrathin colonoscopes in ulcerative colitis patients. Dig Endosc 2015; 27:99-105. [PMID: 24995962 DOI: 10.1111/den.12323] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM In patients with ulcerative colitis (UC), colonoscopy is an essential procedure for evaluating mucosal damage, and treatment outcomes. A new flexible ultrathin colonoscope (PCF-PQ260) has been developed to readily pass through tortuous and narrow lesions of the colon and cause minimum patient discomfort. The objective of the present study was to evaluate the comfort and performance of this new type of scope in UC patients who underwent colonoscopy for estimation of mucosal inflammation, basically without sedation. METHODS In a prospective, single-center setting, among 107 UC patients who were to undergo colonoscopy, 84 eligible cases were randomly assigned to the new ultrathin flexible colonoscope, PCF-PQ260 (n = 42) or to a conventional colonoscope, PCF-Q260A (n = 42). Main outcome measure was patient pain level determined by visual analogue scale (VAS) with 0 = none, and 100 = extremely painful. Other outcomes were cecal intubation time, rate of complete intubation (to reach the cecum) and rate of procedural complications. RESULTS VAS score was significantly lower in the new-scope group as compared with the conventional-scope group: mean ± SD, median (range): 19.3 ± 16.9, 14 (0-62) vs 32.0 ± 21.6, 31.8 (0-100, P = 0.005). However, cecal intubation rate (97.6%) and time (4 min) were similar in the two groups. There was no procedure-related serious complication in either group. CONCLUSION The findings indicated that the flexible ultrathin colonoscope PCF-PQ260 has significantly better tolerability in UC patients compared to a conventional colonoscope.
Collapse
Affiliation(s)
- Tomohiro Ogawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hordonneau C, Buisson A, Scanzi J, Goutorbe F, Pereira B, Borderon C, Da Ines D, Montoriol PF, Garcier JM, Boyer L, Bommelaer G, Petitcolin V. Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease: validation of quantitative index of activity. Am J Gastroenterol 2014; 109:89-98. [PMID: 24247212 DOI: 10.1038/ajg.2013.385] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/01/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) allows accurate assessment of Crohn's disease (CD), but requires gadolinium injection. Diffusion-weighted (DW)-MRI yields comparable performances in small bowel CD. We compared the accuracy of DW-MR enterocolonography (MREC) and the magnetic resonance index of activity (MaRIA), and performed an external validation of the Clermont score in assessing inflammation in CD. METHODS This was an observational prospective study of a single-center cohort. A total of 130 CD patients underwent consecutively MREC with gadolinium injection and DWI sequences between July 2011 and December 2012. RESULTS Of the 848 evaluated segments (small bowel=352, colon/rectum=496), 175 (20.6%) were active (small bowel=111, colon/rectum=64) defined as MaRIA ≥7. Using a receiver operating characteristic (ROC) curve, we determined an apparent coefficient of diffusion (ADC) threshold of 1.9 × 10(-3) mm(2)/s that yielded a sensitivity and a specificity in discriminating active from nonactive CD of 96.9% and 98.1%, respectively, for the colon/rectum, and 85.9% and 81.6%, respectively, for the ileum. ADC was better correlated to MaRIA ≥7 than related contrast enhancement obtained with injected sequences (P<0.001). The Clermont score (=1.646 × bowel thickness-1.321 × ADC+5.613 × edema+8.306 × ulceration+5.039) was highly correlated with the MaRIA (rho=0.99) in ileal CD but not in colonic CD (rho <0.80). Interobserver agreement was high with regard to ADC measurement (correlation >0.9, P<0.001, and concordance >0.9, P<0001). CONCLUSIONS DW-MREC is a reliable tool to assess inflammation in colonic (ADC) and ileal (Clermont score) CD and its use in daily practice would avoid gadolinium injection.
Collapse
Affiliation(s)
- C Hordonneau
- 1] Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France [2] These authors contributed equally to this work
| | - A Buisson
- 1] Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France [2] Microbes, Inflammation, Intestine and Susceptibility of the Host, UMR 1071 INSERM/Auvergne University USC-INRA 2018, Clermont-Ferrand, France [3] These authors contributed equally to this work
| | - J Scanzi
- Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - F Goutorbe
- Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit, University Hospital of Clermont-Ferrand, DRCI, Clermont-Ferrand, France
| | - C Borderon
- Department of Paediatrics, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - D Da Ines
- Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - P F Montoriol
- Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - J M Garcier
- Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - L Boyer
- Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| | - G Bommelaer
- 1] Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France [2] Microbes, Inflammation, Intestine and Susceptibility of the Host, UMR 1071 INSERM/Auvergne University USC-INRA 2018, Clermont-Ferrand, France
| | - V Petitcolin
- Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
26
|
Annese V, Daperno M, Rutter MD, Amiot A, Bossuyt P, East J, Ferrante M, Götz M, Katsanos KH, Kießlich R, Ordás I, Repici A, Rosa B, Sebastian S, Kucharzik T, Eliakim R. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7:982-1018. [PMID: 24184171 DOI: 10.1016/j.crohns.2013.09.016] [Citation(s) in RCA: 550] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/20/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Vito Annese
- Dept. Gastroenterology, University Hospital Careggi, Largo Brambilla 3, 50139 Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|