Journal of Crohn's & colitis最新文献

{"title":"Janus kinase inhibitors in the management of acute severe ulcerative colitis: a comprehensive review.","authors":"Javier P Gisbert, María Chaparro","doi":"10.1093/ecco-jcc/jjaf021","DOIUrl":"10.1093/ecco-jcc/jjaf021","url":null,"abstract":"<p><strong>Background: </strong>One-third of patients with acute severe ulcerative colitis (ASUC) are steroid-refractory. Cyclosporine and infliximab are currently the mainstays of salvage therapy. Janus kinase inhibitors (JAKi) could play a role in the treatment of ASUC.</p><p><strong>Aim: </strong>To review the evidence on JAKi in the management of ASUC.</p><p><strong>Methods: </strong>We performed a bibliographic search to identify studies focusing on the treatment of ASUC with JAKi.</p><p><strong>Results: </strong>Potential advantages of JAKi for the management of ASUC include their oral administration, rapid onset of action, short half-life, lack of immunogenicity, and effectiveness in patients with prior biologic exposure. Thirty studies (including 373 patients) have evaluated the efficacy of tofacitinib in ASUC, with a response rate (avoidance of colectomy) ranging between 43% and 100%, with a weighted mean of 82%. Experience with upadacitinib is more limited (only 10 studies and 74 patients are available) but also encouraging: mean colectomy-free rate ranging between 67% and 100%, with a weighted mean of 79%. However, experience with filgotinib in ASUC is currently nonexistent. Regarding safety, the available data does not reveal any new safety concerns when JAKi are used in ASUC, although follow-up periods are still short.</p><p><strong>Conclusion: </strong>JAKi seems to be a promising treatment option for ASUC, with both tofacitinib and upadacitinib achieving colectomy-free rates of approximately 80%. Further studies are essential to define whether JAKi can replace cyclosporine/infliximab as second-line therapy for the medical management of ASUC, or whether they can even be used as initial treatment in place of intravenous corticosteroids.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lysophosphatidylcholine-Induced Aberrant Adipogenesis in Mesenchymal Stem Cells and Impaired Antibacterial Function in Adipocytes of Creeping Fat.","authors":"Fangting Wu, Wenting Xie, Anqi Yu, Xiaoxia Lin, Ting Ouyang, Jieying Fei, Xi Liu, Hui Yang, Da Zhang, Jintao Shi, Weidong Wang, Miaoxing Huang, Guiquan Chen, Fang Xie, Fengfei Wu, Lan Bai","doi":"10.1093/ecco-jcc/jjaf019","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf019","url":null,"abstract":"<p><strong>Background and aim: </strong>Creeping fat (CF) in Crohn's disease (CD) is characterized by hyperplastic mesenteric adipose tissue (MAT) encasing fibrotic intestinal segments. CF exhibits disruptions in microbiota and lipid metabolism, particularly in lysophospholipids (LPC). This study aims to elucidate the impact of LPC on adipogenic differentiation of mesenchymal stem cells in CF and its effects on immune defense functions in the differentiated adipocytes.</p><p><strong>Methods: </strong>Isolated adipocytes of MAT from CD and Non-CD patients were analyzed for bacterial counts and composition using AQ-PCR and 16S rRNA. RNA sequencing was performed on isolated adipocytes to assess functionality. LPC levels in CD patients and their effects on adipocyte immune defense were measured using lipidomics, ELISA, and bacterial killing assays. A TNBS-induced colitis model was used to measure LPC levels in plasma and gene expression in MAT.</p><p><strong>Results: </strong>Significant shifts in microbial diversity and bacterial load were observed in CF-derived adipocytes, characterized by increased colonization by pathogenic bacteria and diminished antibacterial capabilities. Sequencing analysis revealed downregulation of antimicrobial genes, including SAA1/2, and upregulation of lipid metabolism-related genes. Lipidomic analysis of CF showed elevated LPC levels, a pro-inflammatory lipid also found in plasma of CD patients. In vitro experiments demonstrated LPC promotes adipogenesis through EGR2, while impairing adipocytes' antibacterial immunity. These findings were consistent in the TNBS-treated mouse model, where increased LPC levels in the blood, and a significant reduction in SAA1/2-positive adipocytes were noted.</p><p><strong>Conclusions: </strong>LPC-induced aberrant adipogenesis in CF is a newly identified pathological feature in CD patients and a potential therapeutic target.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory bowel diseases in the elderly population: epidemiology, long-term disease course, surgery rates, and biological use-data from the Veszprem county cohort between 1977 and 2020.","authors":"Dorottya Angyal, Lorant Gonczi, Fruzsina Balogh, Panu Wetwittayakhlang, Petra A Golovics, Tunde Pandur, Gyula David, Zsuzsanna Erdelyi, Istvan Szita, Akos Ilias, Laszlo Lakatos, Peter L Lakatos","doi":"10.1093/ecco-jcc/jjaf003","DOIUrl":"10.1093/ecco-jcc/jjaf003","url":null,"abstract":"<p><strong>Background and aims: </strong>Limited data are available on long-term disease outcomes in elderly-onset (EO) inflammatory bowel diseases (IBD) from well-defined population-based cohorts. Our aim was to analyze incidence, disease course, surgery rates, and therapeutic strategies of EO IBD in a prospective population-based cohort.</p><p><strong>Methods: </strong>Elderly-onset inflammatory bowel diseases were defined if diagnosis was established at ≥60 years of age. Patient inclusion lasted between 1977 and 2018. Study endpoints were compared between elderly- and adult-onset (AO) patients and different therapeutic eras. Data from medical records were prospectively collected and regularly reviewed, as part of the well-established Veszprem IBD cohort.</p><p><strong>Results: </strong>Data from 946 Crohn's disease (CD) and 1370 ulcerative colitis (UC) patients were analyzed. The proportion of EO CD and UC patients was 6.1% (58/946) and 13.4% (183/1370) in the total cohort. Biological therapy exposure was significantly lower in EO CD compared to AO [pLogRank = 0.003], but similar exposure was seen amongst UC patients [pLogRank = 0.770]. Early surgery rates (≤1 year from diagnosis) were significantly higher in EO CD patients compared to AO (27.6% vs 15.6%; P < .001). However, there was no statistically significant difference in overall resective surgery rates between the EO and AO cohorts in CD [pLogRank = 0.838], nor colectomy rates differed in UC [pLogRank = 0.435]. Disease phenotype progression in CD and UC were both lower in EO disease [pLogRank = 0.015; pLogRank = 0.022].</p><p><strong>Conclusion: </strong>Elderly-onset inflammatory bowel diseases represents an increasing proportion of IBD patients, with high exposure to biologicals in EO UC. Overall surgery rates were similar in EO and AO cohorts, however, early surgeries in CD were higher in EO patients.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Endoscopic Activity and Classification of Lesions With Panenteric Capsule Endoscopy in Patients Treated for Crohn's Disease-A Prospective Blinded Comparison With Ileocolonoscopy, Fecal Calprotectin, and C-Reactive Protein.","authors":"Jacob Broder Brodersen, Jens Kjeldsen, Mie Agerbæk Juel, Torben Knudsen, Søren Rafael Rafaelsen, Michael Dam Jensen","doi":"10.1093/ecco-jcc/jjae124","DOIUrl":"10.1093/ecco-jcc/jjae124","url":null,"abstract":"<p><strong>Background and aims: </strong>Panenteric capsule endoscopy (PCE) is a minimally invasive modality that may replace ileocolonoscopy (IC) in selected patients with Crohn's disease (CD). This study aimed to evaluate the dynamics of repeated assessment with PCE in patients receiving medical treatment for ileocolonic CD.</p><p><strong>Methods: </strong>This prospective, blinded, multicenter study included patients with endoscopically active CD. Patients were scheduled for IC, PCE, fecal calprotectin, and C-reactive protein before and 12 weeks after treatment with corticosteroids or biological therapy. The endoscopic disease activity was assessed with the Simple Endoscopic Score for Crohn's Disease (SES-CD).</p><p><strong>Results: </strong>Thirty-one patients entered the study, and PCE visualized 148 (95.5%) and 128 (82.6%) ileocolonic bowel segments before and after medical treatment, respectively. The median SES-CD decreased from 14 (interquartile range [IQR] 8-17) to 5 (IQR 0-14) (p < 0.001) and 14 (IQR 10-17) to 6 (IQR 3-12) (p < 0.001) with IC and PCE, respectively. The repeated measures correlation between PCE and IC was very strong (r = 0.77, p < 0.001), strong compared to fecal calprotectin (r = 0.42, p = 0.003), and moderate compared to C-reactive protein (r = 0.36, p = 0.005). The mean scores for ulcer size, ulcerated surface, and affected surface were comparable between PCE and IC both before and after treatment. PCE had a sensitivity and specificity of 80.6% (95% confidence interval [95% CI] 62.5-92.5) and 93.8% (95% CI 79.2-99.2), respectively, for ulcer healing compared to IC.</p><p><strong>Conclusions: </strong>PCE is responsive in patients treated for CD and may serve as a minimally invasive alternative to IC in selected patients.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-assisted Video Colonoscopy for Disease Monitoring of Ulcerative Colitis: A Prospective Study.","authors":"Noriyuki Ogata, Yasuharu Maeda, Masashi Misawa, Kento Takenaka, Kaoru Takabayashi, Marietta Iacucci, Takanori Kuroki, Kazumi Takishima, Keisuke Sasabe, Yu Niimura, Jiro Kawashima, Yushi Ogawa, Katsuro Ichimasa, Hiroki Nakamura, Shingo Matsudaira, Seiko Sasanuma, Takemasa Hayashi, Kunihiko Wakamura, Hideyuki Miyachi, Toshiyuki Baba, Yuichi Mori, Kazuo Ohtsuka, Haruhiko Ogata, Shin-Ei Kudo","doi":"10.1093/ecco-jcc/jjae080","DOIUrl":"10.1093/ecco-jcc/jjae080","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>The Mayo endoscopic subscore [MES] is the most popular endoscopic disease activity measure of ulcerative colitis [UC]. Artificial intelligence [AI]-assisted colonoscopy is expected to reduce diagnostic variability among endoscopists. However, no study has been conducted to ascertain whether AI-based MES assignments can help predict clinical relapse, nor has AI been verified to improve the diagnostic performance of non-specialists.</p><p><strong>Methods: </strong>This open-label, prospective cohort study enrolled 110 patients with UC in clinical remission. The AI algorithm was developed using 74 713 images from 898 patients who underwent colonoscopy at three centres. Patients were followed up after colonoscopy for 12 months, and clinical relapse was defined as a partial Mayo score > 2. A multi-video, multi-reader analysis involving 124 videos was conducted to determine whether the AI system reduced the diagnostic variability among six non-specialists.</p><p><strong>Results: </strong>The clinical relapse rate for patients with AI-based MES = 1 (24.5% [12/49]) was significantly higher [log-rank test, p = 0.01] than that for patients with AI-based MES = 0 (3.2% [1/31]). Relapse occurred during the 12-month follow-up period in 16.2% [13/80] of patients with AI-based MES = 0 or 1 and 50.0% [10/20] of those with AI-based MES = 2 or 3 [log-rank test, p = 0.03]. Using AI resulted in better inter- and intra-observer reproducibility than endoscopists alone.</p><p><strong>Conclusions: </strong>Colonoscopy using the AI-based MES system can stratify the risk of clinical relapse in patients with UC and improve the diagnostic performance of non-specialists.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-omics data integration identifies novel biomarkers and patient subgroups in inflammatory bowel disease.","authors":"António José Preto, Shaurya Chanana, Daniel Ence, Matthew D Healy, Daniel Domingo-Fernández, Kiana A West","doi":"10.1093/ecco-jcc/jjae197","DOIUrl":"10.1093/ecco-jcc/jjae197","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), is a complex condition with diverse manifestations; recent advances in multi-omics technologies are helping researchers unravel its molecular characteristics to develop targeted treatments.</p><p><strong>Objectives: </strong>In this work, we explored one of the largest multi-omics cohorts in IBD, the Study of a Prospective Adult Research Cohort (SPARC IBD), with the goal of identifying predictive biomarkers for CD and UC and elucidating patient subtypes.</p><p><strong>Design: </strong>We analyzed genomics, transcriptomics (gut biopsy samples), and proteomics (blood plasma) from hundreds of patients from SPARC IBD. We trained a machine learning model that classifies UC versus CD samples. In parallel, we integrated multi-omics data to unveil patient subgroups in each of the 2 indications independently and analyzed the molecular phenotypes of these patient subpopulations.</p><p><strong>Results: </strong>The high performance of the model showed that multi-omics signatures are able to discriminate between the 2 indications. The most predictive features of the model, both known and novel omics signatures for IBD, can potentially be used as diagnostic biomarkers. Patient subgroup analysis in each indication uncovered omics features associated with disease severity in UC patients and with tissue inflammation in CD patients. This culminates with the observation of 2 CD subpopulations characterized by distinct inflammation profiles.</p><p><strong>Conclusions: </strong>Our work unveiled potential biomarkers to discriminate between CD and UC and to stratify each population into well-defined subgroups, offering promising avenues for the application of precision medicine strategies.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding the proteomic landscape of inflammatory bowel disease.","authors":"Peter Cartlidge, Gwo-Tzer Ho, Rahul Kalla","doi":"10.1093/ecco-jcc/jjaf008","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf008","url":null,"abstract":"","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific Bacterial Co-abundance Groups Are Associated With Inflammatory Status in Patients With Ulcerative Colitis.","authors":"Sushrut Jangi, Naisi Zhao, Katie Hsia, Young Soo Park, Dominique S Michaud, Hyuk Yoon","doi":"10.1093/ecco-jcc/jjae125","DOIUrl":"10.1093/ecco-jcc/jjae125","url":null,"abstract":"<p><strong>Background and aims: </strong>While there is increasing interest in microbiome-directed therapies for patients with ulcerative colitis (UC), the identification of microbial targets remains elusive, underlining the need for novel approaches.</p><p><strong>Methods: </strong>Utilizing metagenomic data from the Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease (SPARC IBD), available via the IBD Plexus Program of the Crohn's & Colitis Foundation, we used a tree-based dichotomous approach to assemble distinct clusters of species-level bacterial co-abundance groups (CAGs). We evaluated the abundance of bacterial CAGs and fungal taxa during remission (n = 166) and activity (n = 46). We examined if the bacterial CAGs identified in our cohorts were conserved in 2 healthy cohorts and a Korean UC cohort.</p><p><strong>Results: </strong>CAG3 and CAG8, dominated by bacteria from the family Lachnospiraceae, were associated with remission. Low abundance of CAG8 and elevated abundance of Candida genus were predictive of active UC. Constituents from CAG8 were influential hub species of the remission-associated microbial UC network, including Ruminococcus gnavus, Erysipelatoclostridium ramosum, Blautia, and Dorea species. These hub species interactions were preserved in 2 healthy cohorts and were partially recapitulated in a Korean UC cohort. CAG8 abundance correlated with the secondary bile acid production pathway. Bacterial CAGs did not correlate with Candida; however, Bifidobacterium adolescentis and Alistipes putredinis were negatively associated with Candida.</p><p><strong>Conclusions: </strong>Lachnospiraceae-dominated bacterial CAGs were associated with remission in UC, with key bacterial interactions within the CAG also observed in 2 healthy cohorts and a Korean UC cohort. Bacterial CAG-based analyses may aid in designing candidate consortia for microbiome-based therapeutics.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discordant Effects of Janus Kinase Inhibition Ex Vivo on Inflammatory Responses in Colonic Compared to Ileal Mucosa.","authors":"Kawsar Kaboub, Hanan Abu-Taha, Jessica Arrouasse, Efrat Shaham-Barda, Nir Wasserberg, Lucille Hayman-Manzur, Adi Friedenberg, Adva Levy-Barda, Idan Goren, Zohar Levi, Hagar Banai-Eran, Irit Avni-Biron, Jacob E Ollech, Tali Sharar-Fischler, Henit Yanai, Sarit Cohen-Kedar, Iris Dotan, Keren M Rabinowitz","doi":"10.1093/ecco-jcc/jjae117","DOIUrl":"10.1093/ecco-jcc/jjae117","url":null,"abstract":"<p><strong>Background and aims: </strong>Janus kinase [JAK] inhibitors are used for treating inflammatory bowel diseases [IBD]. We aimed to identify the molecular effects of JAK inhibition in human intestinal mucosa, considering IBD location and phenotype.</p><p><strong>Methods: </strong>Colonic and ileal explants from patients with ulcerative colitis [UC], Crohn's disease [CD], and non-IBD controls [NC] were assessed for levels of phosphorylated signal transducers and activators of transcription [p-STAT] and expression of inflammatory genes in response to an ex vivo JAK inhibitor [tofacitinib]. Cytokine production by lamina propria lymphocytes in response to tofacitinib was assessed. Human intestinal organoids were used to investigate the effects of JAK inhibitors on inducible nitric oxide synthase [iNOS] expression.</p><p><strong>Results: </strong>Explants were collected from 68 patients [UC = 20, CD = 20, NC = 28]. p-STAT1/3/5 inhibition rates varied, being higher in colonic compared to ileal explants. p-STAT1/3 inhibition rates negatively correlated with levels of C-reactive protein [CRP]. While significant alterations in 120 of 255 inflammatory genes were observed in colonic explants, only 30 were observed in ileal NC explants. In colonic explants from UC, significant alterations were observed in five genes, including NOS2. JAK inhibition significantly decreased Th1/Th2/Th17-related cytokine production from lamina propria lymphocytes. Various JAK inhibitors reduced the interferon-γ-induced increase in iNOS expression in organoids.</p><p><strong>Conclusions: </strong>A site-specific anti-inflammatory effect of JAK inhibition by tofacitinib was noted, whereby the colon was more robustly affected than the ileum. The ex vivo response to tofacitinib is individual. JAK inhibition may attenuate inflammation by decreasing iNOS expression. Ex vivo mucosal platforms may be a valuable resource for studying personalized drug effects in patients with IBD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fecal Calprotectin Diagnostic Level Gradient Along the Small Bowel in Patients With Crohn's Disease.","authors":"Offir Ukashi, Uri Kopylov, Bella Ungar, Adi Talan Asher, Eyal Shachar, Tal Engel, Ahmad Albshesh, Doron Yablecovitch, Adi Lahat, Rami Eliakim, Shomron Ben-Horin","doi":"10.1093/ecco-jcc/jjae123","DOIUrl":"10.1093/ecco-jcc/jjae123","url":null,"abstract":"<p><strong>Background and aims: </strong>Fecal calprotectin (FC) is known to be a sensitive biomarker of colonic inflammation but to a lesser degree of small bowel (SB) inflammation. Moreover, data on FC's diagnostic levels in different SB segments are scarce. We aimed to examine FC's diagnostic levels along the SB axis in CD.</p><p><strong>Methods: </strong>This was a post hoc aggregated analysis of 5 prospective studies of adult CD patients who underwent FC testing and SB video capsule endoscopy. Lewis score (LS) inflammation in different SB segments was tested for correlation with FC level after the exclusion of colonic disease. The diagnostic levels of FC for SB inflammatory topographical gradient were assessed using a receiver operating characteristic.</p><p><strong>Results: </strong>Two hundred and fourteen patients were included (age: 30 [24-43] year-old, males-57%). For a similar SB inflammatory activity (LS ≥ 135), FC levels incrementally increased from proximal to distal SB segments (63 [30-121] vs 190 [78-549], p = 0.005) and from distal SB segment to the colon (190 [78-549] vs 542 [185-1000], p = 0.010). The best FC cutoffs to identify isolated mild proximal/distal SB inflammation (LS ≥ 135) were 77 µg/g and 123 µg/g, respectively. A cutoff of 234 µg/g was best to detect more significant proximal inflammation (LS ≥ 350) when only mild distal SB inflammation was present. In sensitivity analyses, this proximal-to-distal FC gradient was maintained when LS ≥ 350 and LS ≥ 790 were used as the inflammatory reference values. Unlike FC, the magnitude of CRP elevation was unrelated to the topography of inflammation along the SB axis.</p><p><strong>Conclusions: </strong>FC may serve as a topographical biomarker of CD-activity, with its sensitivity to identify mucosal inflammation increases from proximal to distal SB segments.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}