title: Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease.
abstract: In adult inflammatory bowel disease (IBD) patients, there is a strong discrepancy between symptoms and biomarkers of inflammation. Data on pediatric IBD patients are conflicting. Therefore, we aimed to investigate the relationship between clinical symptoms and biomarkers of inflammation in pediatric IBD. Patients aged <18 years with previously diagnosed Crohn's disease (CD) or ulcerative colitis (UC) were included. Clinical disease activity was determined using the abbreviated Pediatric CD Activity Index (aPCDAI) or Pediatric UC Activity Index (PUCAI). Biochemical disease activity was assessed using fecal calprotectin (FC) and C-reactive protein (CRP). In total, 127 patients (62 male; median age 14.9 years) were included (82 CD, 45 UC). FC correlated weakly with total aPCDAI score (r s = 0.32; 95 % CI 0.12-0.51; p = 0.003) and total PUCAI score (r s = 0.36; 95 % CI 0.07-0.62; p = 0.015). Only aPCDAI components abdominal examination and perirectal disease and PUCAI component activity level had a significant correlation with levels of FC. CRP correlated weakly with total aPCDAI score (r s = 0.28; 95 % CI 0.05-0.46; p = 0.012) and aPCDAI components abdominal examination and activity level. No significant correlation was observed between CRP and total PUCAI score (r s = 0.01; 95 % CI -0.34-0.29; p = 0.961) or individual PUCAI components.
  
  
  CONCLUSIONS
  There is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.
  
  
  BACKGROUND
  • A substantial proportion of asymptomatic pediatric inflammatory bowel disease (IBD) patients have elevated biomarkers of inflammation. • There is a strong discrepancy between symptoms and biomarkers of inflammation in adults with IBD. What is New: • Clinical symptoms are only weakly associated with levels of fecal calprotectin and serum C-reactive protein in children and adolescents with previously diagnosed IBD. • Similarly to adult IBD patients, there is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.
authors: Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Daniël R
authors: DR
authors: Hoekman
authors: Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Kay
authors: K
authors: Diederen
authors: Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Bart G P
authors: BG
authors: Koot
authors: Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Merit M
authors: MM
authors: Tabbers
authors: Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Angelika
authors: A
authors: Kindermann
authors: Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.a.benninga@amc.uva.nl.
authors: Marc A
authors: MA
authors: Benninga
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications* / Q000378:metabolism; D003424:Crohn Disease / Q000150:complications* / Q000378:metabolism; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein
keywords: Crohn’s disease; Disease activity; Fecal calprotectin; Inflammatory bowel disease; Ulcerative colitis