Diagnosing Crohn's Disease In Remission

[lisab]

If Crohn's Disease is in remission at the time of a colonoscopy, can there still be evidence of disease? I know there is no definitive test for it, but colonoscopies do provide clues sometimes. Are those clues there only during a flare-up?

 

[SW VandeCarr]

If Crohn's Disease is in remission at the time of a colonoscopy, can there still be evidence of disease? I know there is no definitive test for it, but colonoscopies do provide clues sometimes. Are those clues there only during a flare-up?

There is evidence of increased activity of immunocompetent cells and increased levels of the cytokine TNF-$\alpha$ (tumor necrosis factor) in the intestinal mucosa during at least some remissions. It's not clear how specific this is for Crohn's disease if no prior diagnosis has been made, nor is it clear that this is the case during long remissions (years) with or without ongoing treatment.

Otherwise the best evidence for prior activation of undiagnosed Crohn's disease is the patient's personal and family history AFAIK. Fistulas, intestinal wall thickening and localized narrowing of the intestinal lumen are evidence of recent inflammatory bowel disease activation.

http://onlinelibrary.wiley.com/stor...1590A84005ACD2.d02t02?v=1&t=hla204cu&d771f933

The link is blocked for me. The reference is Aliment. Pharmacol. Ther. 2002; 16 (supple. 4) 29-33

 

[lisab]

That's about what I suspected. Thanks!

I guess the silver lining is, when it's in remission there are no symptoms at all.

 

[franklinwu]

The definition of clinical remission is a lack of symptoms. Endoscopically this translates into mucosal healing. For further reading please see

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277196/

 

[lisab]

The definition of clinical remission is a lack of symptoms. Endoscopically this translates into mucosal healing. For further reading please see

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277196/

Thanks, that's an interesting article.

 

[SW VandeCarr]

I copied the abstract of the reference in my first post. You can get the full article by pasting the reference (not the link) into a google search. You'll have to scroll down the page past other articles to "Monitoring the activity of Crohn's disease. Biancone 2002."

"Crohn's disease is characterized by a chronic inflammation of the intestine of unknown aetiology. One of the main problems when treating patients with Crohn's disease, is the identification of patients undergoing early clinical relapse, for timely treatment and the possible prevention of complications. No sub-clinical markers are currently available that predict relapse during remission. Several parameters have been proposed for this purpose. Although none have proven useful, growing evidence suggests a possible benefit in the clinical management of Crohn's disease. Among these, we may identify: clinical behaviour, the characteristics of the host, clinical activity, markers of intestinal inflammation and markers of immune activation. In particular, the possible relationship between cytokine pattern and the clinical behaviour of Crohn's disease has been addressed. Overall, these observations suggest that mucosal immune activation is a feature of Crohn's disease, and may persist in the form of activated immunocompetent cells during remission. On the basis of this evidence, studies are currently investigating whether the down-regulation of immune activation markers is associated with clinical remission in Crohn's disease. It has been shown that higher mucosal levels of TNF-α and an increased state of activation of lamina propria mononuclear cells in patients with inactive Crohn's disease, are significantly associated with an earlier clinical relapse of the disease. These observations suggest that a persistent local immune activation during remission may represent a marker of early clinical relapse of Crohn's disease."