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Inflammatory bowel diseases: where we are and where we should go
| Content Provider | Semantic Scholar |
|---|---|
| Author | Tonutti, Elio Agostinis, Paolo Bizzaro, Nicola |
| Copyright Year | 2014 |
| Abstract | In Western countries, and especially in the Mediterranean area, inflammatory bowel diseases (IBD) show an increasing epidemiological trend as measured by incidence per year. Data is more evident for Crohn's disease than for ulcerative colitis, although some differences exist according to geographical area [1]. The causes of the increase are not clear, but dietary habits and environmental or socioeconomic factors seem to play an important role in the onset of IBD, especially Crohn's disease [2]. The costs of these chronic diseases are very high as patients require strict monitoring, a continuous use of pharmacological therapy, and often surgical treatment at a rate of 30% for ulcerative colitis and 70% for Crohn's disease [3]. As there are no symptoms, biochemical changes, pathological features or endoscopic findings that can be considered completely specific for Crohn's disease or for ulcerative colitis, it is not always easy to distinguish between these two forms. The symptoms can be confounded with irritable bowel syndrome, which, in the Western world, is the gastroenteric condition for which patients most frequently request a medical consultation; or with infectious diseases, be they protozoan, parasitic, or bacterial in nature. The frequency of the latter is also growing in the West due to immigration from other continents. Echography of the intestine is endowed with a very high sensitivity for detecting thickening of the wall of the terminal ileum, expression of edema and inflammation; and can differentiate in minutes at the patient bedside between an inflammatory disease and a functional disturbance. However, specificity is low and the method does not distinguish an IBD from an infectious disease. Anti-Saccharomyces cerevisiae antibodies (ASCA) are widely used as a means for diagnosing Crohn's disease, but the sensitivity is in the range of 40%–60%. Their specificity is not absolute as ASCA may be present in patients with celiac disease or intestinal tuberculosis, suggesting that they may reflect a non-specific immune response in the course of various types of small bowel disease. Acute phase reactants such as ESR and protein C-reactive are generally elevated but they can be normal even in the stages where the disease is active or severe. Thus, to date, colonoscopy with terminal ileoscopia is the standard means for the diagnosis of IBD, after excluding infectious and inflammatory granulomatous diseases such as tuberculosis, Yersinia infection, schistosomiasis, lymphoma and Behçet's disease. For these reasons, there is a constant push to find diagnostic and monitoring approaches which are low in cost and minimally invasive, but still able to support diagnosis, stratify and sub-classify IBD and predict therapy response. The two articles of Basso [4] and Roggenbuck [5] in this issue of Clinical Chemistry and Laboratory Medicine (CCLM) provide important data to support this push, based on three fundamental aspects. The first regards the use of fecal markers of inflammation: lactoferrin and calprotectin. These markers have been used for many years in clinical practice, both as a diagnostic confirmation and in monitoring IBD. The work of Basso and co-authors gives a detailed view of the clinical significance and diagnostic applications which highlights the possibility of measuring these markers with different methods and diverse types of instrumentation; the rapid immunochromatographic test (point-of-care tests; FC-POCT) for measuring calprotectin can be very useful in specialist clinics where it is decided whether or not to pursue colonoscopy in a suspected IBD case. In these cases, a semi-quantitative or even a qualitative test might have a relevant role in the diagnostic decisional process. The measuring of fecal markers with random access instruments or with ELISA methods, however, falls to the laboratory where quantitative results must be returned quickly, using analytical methods with a wide linear range for therapeutic decision-making. The second aspect regards the significance and use of IBD serological markers. The contributions of Basso and Roggenbuck offer a complete panorama of markers that can be used in clinical laboratories, reporting the data from the most recent literature on clinical applications in the diagnostic arena for monitoring and subclassification of IBDs. |
| Starting Page | 463 |
| Ending Page | 465 |
| Page Count | 3 |
| File Format | PDF HTM / HTML |
| DOI | 10.1515/cclm-2014-0146 |
| PubMed reference number | 24583463 |
| Journal | Medline |
| Volume Number | 52 |
| Alternate Webpage(s) | https://www.degruyter.com/downloadpdf/j/cclm.2014.52.issue-4/cclm-2014-0146/cclm-2014-0146.pdf |
| Alternate Webpage(s) | https://doi.org/10.1515/cclm-2014-0146 |
| Journal | Clinical chemistry and laboratory medicine |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
