Gastric trichobezoar in the absence of psychosocial stressors: a report of two cases.

Abstract.

Surrogate Markers of Intestinal Inflammation in Paediatric Patients with Inflammatory Bowel Disease.

BACKGROUND: Endoscopic evaluation is the gold standard for monitoring the disease activity in inflammatory bowel disease (IBD) but the procedure is invasive and not appropriate for frequent use, especially in the paediatric population. The aim of the present study was to assess the correlation between the levels of several inflammatory biomarkers and the degree of intestinal inflammation in paediatric patients with IBD. MATERIALS AND METHODS: A single center study including 31 children with ulcerative colitis (UC) and 22 children with Crohn's disease (CD) with different disease duration and activity. All participants provided blood samples to measure the levels of white blood cell count, platelets, C-reactive protein, erythrocyte sedimentation rate, albumin and fibrinogen, and faecal samples for measurement of faecal calprotectin and faecal alpha-1 antitrypsin. All participants underwent endoscopic evaluation. Endoscopic disease activity was assessed according to the Mayo Endoscopic Subscore and Simple Endoscopic Score for Crohn's Disease in UC and CD patients, respectively. RESULTS: 135 visits were included: 73 for UC patients and 62 for CD patients. In UC patients the strongest correlation was between the Mayo Endoscopic Subscore and the faecal calprotectin (r=0.867, p<0.001) followed by the albumin (r=0.523, p<0.001) and the C-reactive protein (r=0.487, p<0.001). In CD the strongest correlation was between the Simple Endoscopic Score for Crohn's disease and the faecal calprotectin (r=0.872, p<0.001) followed by the C-reactive protein (0.708, p<0.001) and the erythrocyte sedimentation rate (0.605, p<0.001). CONCLUSIONS: The faecal calprotectin is a valuable surrogate marker of intestinal inflammation that is useful for monitoring of a disease activity in paediatric patients with IBD.

Role of faecal calprotectin as a predictor of endoscopic activity in paediatric patients with ulcerative colitis / Papel de la calprotectina fecal como predictor de la actividad endoscópica en pacientes pediátricos con colitis ulcerosa

Introduction: Colonoscopy is currently considered to be the gold standard for evaluation of colonic mucosa inflammation in patients with ulcerative colitis (UC), but the procedure is invasive and cannot be repeated frequently, especially in the paediatric population. The aim of this study was to assess the role of faecal calprotectin (FC) as a predictor of endoscopic disease activity in paediatric patients with UC in clinical remission. Material and methods: Single-centre prospective study. Clinical remission was defined as Paediatric Ulcerative Colitis Activity Index <10. Endoscopic findings were assessed according to the Mayo Endoscopic Subscore (MES). MES≤1 was defined as endoscopic remission. All participants provided fresh faecal samples for measurement of FC. Results: A total of 34 visits of 24 children with UC were included in the study. There was a strong positive correlation between FC levels and endoscopic disease activity (n=34, r=0.83, p<0.001). The median FC levels in the subgroup with endoscopic activity (MES 2-3) were significantly higher than the median FC levels in the subgroup without endoscopic activity (MES≤1) (1000μg/g, IQR 575-1800μg/g vs. 100μg/g, IQR 80-223μg/g, p<0.001). At a cut-off of 298.5μg/g, FC had 92.3% sensitivity, 95.2% specificity and an AUROC 0.974 (SE 0.023, 95% CI 0.93-1, p<0.001) to predict endoscopic activity. Discussion: FC is an accurate surrogate marker of endoscopic activity in children with clinically quiescent UC

Introducción: Actualmente, la colonoscopia es considerada como el gold standard para la evaluación de la inflamación de la mucosa colónica en pacientes con colitis ulcerosa (CU), pero este procedimiento es invasivo y no se puede repetir frecuentemente, especialmente en la población pediátrica. El objetivo de este estudio es evaluar el papel de la calprotectina fecal (CF) como predictor de la actividad endoscópica de la enfermedad en pacientes pediátricos con CU en remisión clínica. Material y métodos: Estudio prospectivo monocéntrico. La remisión clínica se definió según el Índice de Actividad Pediátrico de Colitis Ulcerosa (Paediatric Ulcerative Colitis Activity Index) <10. Los hallazgos endoscópicos fueron evaluados según el Subscore Endoscópico de Mayo (SEM). SEM≤1 se definió como remisión endoscópica. En todos los participantes se obtuvo una muestra de heces para medición de la CF. Resultados: Un total de 34 visitas de 24 niños con CU se incluyeron en el estudio. Hubo una fuerte correlación positiva entre la CF y la actividad endoscópica de la enfermedad (n=34, r=0,83, p <0,001). La mediana de los niveles de CF en el subgrupo con actividad endoscópica (SEM 2-3) fue significativamente superior a la mediana de los niveles de CF en el subgrupo sin actividad endoscópica (MES≤1) (1.000 μg/g, IQR 575 μg/g-1.800 μg/g vs. 100 μg/g; IQR 80 μg/g-223 μg/g; p <0,001). Al nivel de corte de 298,5 μg/g la CF obtuvo una sensibilidad del 92,3%, una especificidad del 95,2% y un área bajo la curva de 0,974 (SE 0,023; IC del 95%, 0,93-1; p <0,001) para predecir actividad endoscópica. Discusión: La CF es un marcador indirecto preciso para actividad endoscópica en niños con CU clínicamente quiescente

Role of faecal calprotectin as a predictor of endoscopic activity in paediatric patients with ulcerative colitis.

INTRODUCTION: Colonoscopy is currently considered to be the gold standard for evaluation of colonic mucosa inflammation in patients with ulcerative colitis (UC), but the procedure is invasive and cannot be repeated frequently, especially in the paediatric population. The aim of this study was to assess the role of faecal calprotectin (FC) as a predictor of endoscopic disease activity in paediatric patients with UC in clinical remission. MATERIAL AND METHODS: Single-centre prospective study. Clinical remission was defined as Paediatric Ulcerative Colitis Activity Index <10. Endoscopic findings were assessed according to the Mayo Endoscopic Subscore (MES). MES≤1 was defined as endoscopic remission. All participants provided fresh faecal samples for measurement of FC. RESULTS: A total of 34 visits of 24 children with UC were included in the study. There was a strong positive correlation between FC levels and endoscopic disease activity (n=34, r=0.83, p<0.001). The median FC levels in the subgroup with endoscopic activity (MES 2-3) were significantly higher than the median FC levels in the subgroup without endoscopic activity (MES≤1) (1000µg/g, IQR 575-1800µg/g vs. 100µg/g, IQR 80-223µg/g, p<0.001). At a cut-off of 298.5µg/g, FC had 92.3% sensitivity, 95.2% specificity and an AUROC 0.974 (SE 0.023, 95% CI 0.93-1, p<0.001) to predict endoscopic activity. DISCUSSION: FC is an accurate surrogate marker of endoscopic activity in children with clinically quiescent UC.