Fecal alpha 1-antitrypsin clearance as a marker of clinical relapse in patients with Crohn's disease of the distal ileum.

Abstract

BACKGROUND:

Crohn's disease (CD) shows a chronic relapsing course but no marker of relapse is currently available. However, fecal alpha 1-antitrypsin (alpha 1-AT) clearance (alpha 1-ATCl) is an indicator of protein loss and increases during active inflammation. We assessed the usefulness of fecal alpha 1-ATCl in predicting clinical relapse in patients with inactive ileal CD.

DESIGN:

In a prospective longitudinal study, 26 patients with inactive ileal CD (Crohn's disease activity index (CDAI) < 150) (18 males, mean age 43 +/- 10, range 23-58) were enrolled. Fecal alpha 1-ATCl and concentration, daily stool weight and serum alpha 1-AT were measured at baseline (visit 1), after 1 week (visit 2) and 3 weeks (visit 3) in 24/26 patients (two drop-outs) (short-term study). In six of these 26 patients, fecal alpha 1-ATCl was also measured every 3 months for 1 year (long-term study). All patients were clinically assessed every 3 months for 1 year and every 6 months for 2 years. Ten healthy volunteers were tested as controls.

METHODS:

Serum and fecal alpha 1-AT concentration was quantified by radial immunodiffusion.

RESULTS:

The median fecal alpha 1-ATCl value at baseline was higher in inactive patients undergoing clinical relapse (CDAI > 200) in the next 6 months than in those remaining in remission at 6 months (P = 0.03). Fecal alpha 1-ATCl showed a 75% sensitivity, 85% specificity, 50% positive predictive value and 94% negative predictive value in predicting CD relapse in the next 6 months. In the long-term follow-up, fecal alpha 1-ATCl values increased at 12 months compared with both baseline and 6 month values (P = 0.005; P = 0.009). Fecal alpha 1-ATCl was higher in patients with raised C-reactive protein (P = 0.039).

CONCLUSIONS:

Results from our study suggest that fecal alpha 1-ATCl is an indicator of clinical relapse in patients with CD of the distal ileum under regular surveillance.

• Authors: Livia Biancone, Massimo Fantini, Claudio Tosti, Rosamaria Bozzi, Piero Vavassori, Francesco Pallone
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 15 Issue 3 Pg. 261-6 (Mar 2003) ISSN: 0954-691X [Print] England
• PMID: 12610321 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• alpha 1-Antitrypsin
• C-Reactive Protein

Topics

• Adult
• Biomarkers (analysis)
• C-Reactive Protein (metabolism)
• Crohn Disease (diagnosis, metabolism)
• Feces (chemistry)
• Female
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Recurrence
• Sensitivity and Specificity
• alpha 1-Antitrypsin (analysis)