Anna-Maija Puolanne1, Kaija-Leena Kolho2, Martti Färkkilä1
1
Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland. 2Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Anna-Maija.Puolanne@hus.fi

Background
Fecal calprotectin (FC) is a reliable surrogate marker for inflammatory activity in IBD.  Providing a patient with an option for self–monitoring of the disease has been proven to empower patients, increase adherence and help cut the costs of health care with increasing amount of IBD patients.
For the non-invasive monitoring of the activity of colonic IBD, we validated a symptom score suitable for ulcerative colitis and colonic Crohn’s disease. By combining the symptom score with a rapid semi-quantitative FC test, we constructed a new activity index based on the highest AUC:s , using histological remission as a reference. We also evaluated the correlation of the patient-reported influence of the IBD in the daily life, measured by a VAS scale, with the inflammation activity.

Methods
The disease activity of 72 patients with colonic IBD was determined by endoscopic activity scores (SES-CD / Mayo score). The patients provided stool samples for determination of  FC, and filled out a questionnaire about their symptoms during the last week.

Results
The results of the symptom score demonstrated a statistically significant correlation with the rapid FC test, histological inflammation activity and  the VAS scale. No correlations were found between the VAS scale and FC or the histological inflammation activity. The sensitivity of the combination index to detect active inflammation was superior to FC test alone.

Conclusion
The new symptom score and the combination index are simple and reliable noninvasive means for distinguishing remission from active inflammation in colonic IBD. With the VAS scale we can pick up patients who need psychosocial support because of the disease burden, even if their IBD is in remission.

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