Intestinal permeability test as a predictor of clinical course in Crohn's disease.
OBJECTIVE
The clinical course of Crohn's disease is often unpredictable. The aim of this study was to select the most useful parameters able to predict clinical relapses.


METHODS
One hundred-thirty Crohn's disease patients in clinical remission were followed every 4 months for 2 yr or until clinical relapse. Demographic and clinical data were recorded and intestinal permeability (lactulose/mannitol [L/M] test) and biochemical tests (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, alpha1 acid glycoprotein, and serum iron) were performed at study entry. A subgroup of 54 patients had clinical follow-up and repeated tests every 4 months.


RESULTS
Fifty-two patients (40%) relapsed during the 2-yr follow-up. A significant correlation was found between relapse and gender (p = 0.030) but not between relapse and age, extent and type of disease, previous surgery, or therapy. Increased L/M test (p = 0.0001) and decreased serum iron level (p = 0.0057) were associated with clinical relapse. Time-dependent analysis, performed on patients receiving serial evaluation, showed that L/M test alteration was the only variable that could predict a relapse (RR 8.84, 95% confidence interval [CI] 1.41-53.37; p < 0.05).


CONCLUSIONS
The L/M test identifies Crohn's disease patients in apparent remission, but with a high risk of clinical relapse, better than clinical and biochemical indices. Different treatment strategies might be suggested for this subgroup of patients.
D'Incà
R
R
Division of Gastroenterology, University of Padua, Italy.
Di Leo
V
V
Corrao
G
G
Martines
D
D
D'Odorico
A
A
Mestriner
C
C
Venturi
C
C
Longo
G
G
Sturniolo
G C
GC
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003424:Crohn Disease / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007792:Lactulose; D007958:Leukocyte Count; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D009961:Orosomucoid / Q000032:analysis; D010539:Permeability; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence
D015415:Biomarkers; D009961:Orosomucoid; D008353:Mannitol; D007792:Lactulose; D002097:C-Reactive Protein