title: Intestinal permeability test as a predictor of clinical course in Crohn's disease.
abstract: 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.
authors.affiliation: Division of Gastroenterology, University of Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: D'Incà
authors.forename: V
authors.initials: V
authors.lastname: Di Leo
authors.forename: G
authors.initials: G
authors.lastname: Corrao
authors.forename: D
authors.initials: D
authors.lastname: Martines
authors.forename: A
authors.initials: A
authors.lastname: D'Odorico
authors.forename: C
authors.initials: C
authors.lastname: Mestriner
authors.forename: C
authors.initials: C
authors.lastname: Venturi
authors.forename: G
authors.initials: G
authors.lastname: Longo
authors.forename: G C
authors.initials: GC
authors.lastname: Sturniolo
mesh_terms: 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
chemical_list: D015415:Biomarkers; D009961:Orosomucoid; D008353:Mannitol; D007792:Lactulose; D002097:C-Reactive Protein