P163 Histological activity in Crohn's disease: Relationship with clinical indices, endoscopic activity and faecal calprotectin. (16th January 2018)

• Record Type: Journal Article
• Authors: Buisson, A; Mak, W Y; Andersen Jr, M J; Lei, D; Pekow, J; Cohen, R D; Pereira, B; Setia, N; Weber, C; Hart, J; Rubin, D T
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S179
• Page End: S180
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.290
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: The impact of histological remission is currently investigated in patients with Crohn's disease (CD). In this study, we aimed to assess the relationships between histological activity and (1) clinical activity, (2) endoscopic activity or (3) faecal calprotectin (Fcal), which are still unknown in CD. Methods: From a prospectively maintained database, all CD patients, who had clinical evaluation, endoscopy with biopsies and Fcal measurement (ELISA) within four weeks without therapeutic intervention during this interval, were included. Histological activity was classified as quiescent (histological remission), mild, moderate or severe. The concordance was assessed using the Cohen's kappa coefficient and the agreement rate (%). Results: Among 95 patients, 52.6% were in clinical remission (Harvey-Bradshaw Index ≤ 4) while the median levels of CRP and Fcal were 4.0 mg/l [2.9–7.0] and 298.0 μg/g [60.3–813.0], respectively. Complete mucosal healing (MH) (no endoscopic lesions) and MH (no ulcerations) was observed in 23.2% and 46.4%, respectively. The rate of histological remission was 24.2%. The median level of Fcal was significantly lower in patients with histological remission compared than those with histological activity (36 μg/g vs. 392 μg/g, p < 0.0001). Using a ROC curve, Fcal > 80 µg/g was the best threshold to detect histological activity (AUC = 0.80; sensitivity = 0.86; specificity = 0.74; PPV = 0.91; NPV = 0.63 and accuracy = 0.83). Among the 95 patients, the concordance was poor between histological and clinical remission (κ = 0.21; p < 0.001 and agreement rate = 61.0%), poor between histological remission and MH (κ = 0.32; p < 0.001 and agreement rate = 67.3%), moderate between histological remission and low level of Fcal (< 80 µg/g) (κ = 0.57; p < 0.001 and agreement rate = 83.4%), and substantial between histological remission and complete MH (κ = 0.68; p < 0.001 and agreement rate = 88.6%) (Figure 1). Among the 342 bowel segments, we observed a substantial concordance between histological remission and complete MH (κ = 0.63; p < 0.001 and agreement rate = 72.2%). κ-coefficient was 0.71 ( p < 0.0001) in the ileum ( n = 76), 0.55 ( p < 0.0001) in the right colon ( n = 67), 0.47 ( p < 0.0001) in the transverse colon ( n = 57), 0.68 ( p < 0.0001) in the left/sigmoid colon ( n = 75) and 0.67 ( p < 0.0001) in the rectum ( n = 67). Conclusions: Histological activity demonstrates substantial correlation with endoscopic activity but not with clinical activity in patients with CD. Fcal is a reliable biomarker to assess histological activity in CD.