Endoluminal calprotectin measurement in assessment of pouchitis and a new index of disease activity: a pilot study.
2016
Pouchitis is the most common complication following
proctocolectomy with ileal pouch-anal anastomosis for ulcerative
colitis (UC). To provide a standardized definition of pouchitis
clinical, endoscopic and histological markers were grouped and
weighted in the pouch disease activity index (PDAI). However, the
delay in the assessment of the final score due to the time requested
for histological analysis remains the main obstacle to the index
implementation in clinical practice so that the use of modifiedPDAI
(mPDAI) with exclusion of histologic subscore has been
proposed. We tested the ability of calprotectin measurement in
the pouch endoluminal content to mimic the histologic score as
defined in the PDAI, the index that we adopted as gold standard
for pouchitis diagnosis. Calprotectin was measured by ELISA in
the pouch endoluminal content collected during endoscopy in
40 consecutive patients with J-pouch. In each patient PDAI and
mPDAI were calculated and 15% of patients were erroneously
classified by mPDAI. ROC analysis of calprotectin values vs. acute
histological subscore ≥ 3 identified different calprotectin cut-off
values with corresponding sensitivity and specificity allowing the
definition and scoring of different range of calprotectin subscores.
We incorporated the calprotectin score in the mPDAI obtaining a
new score that shows the same specificity as PDAI for diagnosis of
pouchitis and higher sensitivity when compared with mPDAI. The
use of the proposed new score, once validated in a larger series of
patients, might be useful in the early management of patients with
symptoms of pouchitis.
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