Advertisement

Laboratory Tests

  • Giuseppe Famularo
  • Giovanni Minisola
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

It is unusual for patients with inflammatory bowel disease (IBD) to present with almost specific or pathognomonic clinical symptoms and signs. This implies that diagnosing Crohn’s disease (CD) or ulcerative colitis (UC) is substantially dependent on the combination of a wide range of clinical, radiological, endoscopic, and histological findings that should be correctly interpreted by physicians in the appropriate setting. One additional important point is linked to recent advances in the field that have led to the widespread use of biological therapies in the management of patients with IBD, either CD or UC. This suggests that we urgently need reliable tools to stratify patients with different disease subtypes in terms of the risk of complications and a poor outcome as well as the probability to clinically respond to one treatment strategy, including biological therapies, rather than to others. Reliable tools are also required to appropriately follow-up patients during the course of their disease, especially methods that allow inflammatory activity and treatment effects to be monitored.

Keywords

Inflammatory Bowel Disease Ulcerative Colitis Irritable Bowel Syndrome Inflammatory Bowel Disease Patient Ulcerative Colitis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pepys MB, Hirschfield GM (2003) C-reactive protein: a critical update. J Clin Invest 111:1805–1812PubMedGoogle Scholar
  2. 2.
    Vermeire S, Van Assche G, Rutgeerts P (2004) C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis 10:661–665CrossRefPubMedGoogle Scholar
  3. 3.
    Vermeire S, Van Assche G, Rutgeerts P (2005) The role of C-reactive protein as an inflammatory marker in gastrointestinal diseases. Nat Clin Pract Gastroenterol Hepatol 2:580–586CrossRefPubMedGoogle Scholar
  4. 4.
    Gross V, Andus T, Caesar I et al (1992) Evidence for continuous stimulation of interleukin-6 production in Crohn’s disease. Gastroenterology 102:514–519PubMedGoogle Scholar
  5. 5.
    Tromm A, Tromm CD, Huppe D et al (1992) Evaluation of different laboratory tests and activity indices reflecting the inflammatory activity of Crohn’s disease. Scand J Gastroenterol 27:774–778CrossRefPubMedGoogle Scholar
  6. 6.
    Nielsen OH, Vainer B, Madsen SM et al (2000) Established and emerging biological activity markers of inflammatory bowel disease. Am J Gastroenterol 95:359–367PubMedGoogle Scholar
  7. 7.
    Solem CA, Loftus EV Jr, Tremaine WJ et al (2005) Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis 11:707–712CrossRefPubMedGoogle Scholar
  8. 8.
    Florin TH, Paterson EW, Fowler EV et al (2006) Clinically active Crohn’s disease in the presence of a low C-reactive protein. Scand J Gastroenterol 41:306–311CrossRefPubMedGoogle Scholar
  9. 9.
    Cellier C, Sahmoud T, Froguel E et al (1994) Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn’s disease. A prospective multicentre study of 121cases. The Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives. Gut 35:231–235CrossRefPubMedGoogle Scholar
  10. 10.
    Lemann M, Mary JY, Colombel JF et al (2005) A randomized, double-blind, controlled with-drawl trial in Crohn’s disease patients in long-term remission on azathioprine. Gastroenterology 128:1812–1818CrossRefPubMedGoogle Scholar
  11. 11.
    Boirivant M, Leoni M, Tariciotti D, Fais S, Squarcia O, Pallone F (1988) The clinical significance of serum C reactive protein levels in Crohn’s disease. Results of a prospective longitudinal study. J Clin Gastroenterol 10:401–405CrossRefPubMedGoogle Scholar
  12. 12.
    Travis SP, Farrant JM, Ricketts C et al (1996) Predicting outcome in severe ulcerative colitis. Gut 38:905–910CrossRefPubMedGoogle Scholar
  13. 13.
    Louis E, Vermeire S, Rutgeerts P et al (2002) A positive response to infliximab in Crohn’s disease: association with a higher systemic inflammation before treatment but not with-308 TNF gene polymorphism. Scand J Gastroenterol 37:818–824PubMedGoogle Scholar
  14. 14.
    Beaven SW, Abreu MT (2004) Biomarkers in inflammatory bowel disease. Curr Opin Gastroenterol 20:318–327CrossRefPubMedGoogle Scholar
  15. 15.
    Tibble J, Teahon K, Thjodleifsson B et al (2000) A simple method for assessing intestinal inflammation in Crohn’s disease. Gut 47:506–513CrossRefPubMedGoogle Scholar
  16. 16.
    Poullis A, Foster R, Northfield TC, Mendall MA (2002) Review article: faecal markers in the assessment of activity in inflammatory bowel disease. Aliment Pharmacol Ther 16:675–681CrossRefPubMedGoogle Scholar
  17. 17.
    Aadland E, Fagerhol MK (2002) Faecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol 14:823–825CrossRefPubMedGoogle Scholar
  18. 18.
    Summerton CB, Longlands MG, Wiener K, Shreeve DR (2002) Faecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol 14:841–845CrossRefPubMedGoogle Scholar
  19. 19.
    Costa F, Mumolo MG, Bellini M et al (2003) Role of faecal calprotectin as non-invasive marker of intestinal inflammation. Dig Liver Dis 35:642–647CrossRefPubMedGoogle Scholar
  20. 20.
    Thjodleifsson B, Sigthorsson G, Cariglia N et al (2003) Subclinical intestinal inflammation: an inherited abnormality in Crohn’s disease relatives? Gastroenterology 124:1728–1737CrossRefPubMedGoogle Scholar
  21. 21.
    Bunn SK, Bisset WM, Main MJ et al (2001) Fecal calprotectin: validation as a noninvasive measure of bowel inflammation in childhood inflammatory bowel disease. J Pediatr Gastroenterol Nutr 33:14–22CrossRefPubMedGoogle Scholar
  22. 22.
    Roseth AG, Aadland E, Jahnsen J, Raknerud N (1997) Assessment of disease activity in ulcerative colitis by faecal calprotectin, a novel granulocyte marker protein. Digestion 58:176–180CrossRefPubMedGoogle Scholar
  23. 23.
    Costa F, Mumolo MG, Ceccarelli L et al (2005) Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease. Gut 54:364–368CrossRefPubMedGoogle Scholar
  24. 24.
    Tibble JA, Sigthorsson G, Bridger S et al (2000) Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology 119:15–22CrossRefPubMedGoogle Scholar
  25. 25.
    Roseth AG, Aadland E, Grzyb K (2004) Normalization of faecal calprotectin: a predictor of mucosal healing in patients with inflammatory bowel disease. Scand J Gastroenterol 39:1017–1020CrossRefPubMedGoogle Scholar
  26. 26.
    Vaishnavi C, Kochhar R, Bhasin D et al (2003) Simultaneous assays for Clostridium difficile and faecal lactoferrin in ulcerative colitis. Trop Gastroenterol 24:13–16PubMedGoogle Scholar
  27. 27.
    Kane SV, Sandborn WJ, Rufo PA et al (2003) Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation. Am J Gastroenterol 98:1309–1314CrossRefPubMedGoogle Scholar
  28. 28.
    Silberer H, Kuppers B, Mickisch O et al (2005) Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome. Clin Lab 51:117–126PubMedGoogle Scholar
  29. 29.
    Buderus S, Boone J, Lyerly D, Lentze MJ (2004) Fecal lactoferrin: a new parameter to monitor infliximab therapy. Dig Dis Sci 49:1036–1039CrossRefPubMedGoogle Scholar
  30. 30.
    Ferrante M, Henckaerts L, Joossens M et al (2007) New serological markers in in inflammatory bowel disease are associated with complicated disease behaviour. Gut 56:1394–1403CrossRefPubMedGoogle Scholar
  31. 31.
    Schoepfer AM, Schaffer T, Mueller S et al (2009) Phenotypic associations of Crohn’s disease with antibodies to flagellins A4-Fla2 and Fla-X, ASCA, p-ANCA, PAB, and NOD2 mutations in a swiss cohort. Inflamm Bowel Dis (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Giuseppe Famularo
    • 1
  • Giovanni Minisola
    • 2
  1. 1.Department of Internal MedicineSan Camillo-Forlanini HospitalRome
  2. 2.Rheumatology UnitSan Camillo-Forlanini HospitalRomeItaly

Personalised recommendations