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Alpha1-Antitrypsin Clearance Indicates Relapse In Crohn's Disease
A DGReview of :"Fecal alpha1-antitrypsin clearance as a marker of clinical relapse in patients with Crohn's disease of the distal ileum"
European Journal of Gastroenterology and Hepatology
03/10/2003
By David Loshak
Faecal alpha-antitrypsin clearance is an indicator of clinical relapse in patients with Crohn's disease of the distal ileum.
Noting that Crohn's disease showed a chronic relapsing course but that there was no marker of relapse, investigators in Rome, Italy, pointed out that faecal alpha-antitrypsin clearance was an indicator of protein loss and that it increased during active inflammation. This led them to assess the value of faecal alpha-antitrypsin clearance in predicting clinical relapse.
The study enrolled 24 male and female patients, aged 23 to 58 years, with inactive ileal Crohn's disease. Ten healthy volunteers served as controls.
The investigators measured faecal alpha-antitrypsin clearance and concentration, daily stool weight and serum alpha-antitrypsin at baseline after one week and three weeks. Faecal alpha-antitrypsin clearance was also measured in six patients every three months for one year.
All patients were clinically assessed at 3, 6, 9, 12, 18 and 24 months. Serum and faecal alpha-antitrypsin concentrations were quantified by radial immunodiffusion.
The median faecal alpha-antitrypsin clearance value at baseline was higher in inactive patients undergoing clinical relapse in the next six months than in those still in remission at six months.
Faecal alpha-antitrypsin clearance showed 75% sensitivity, 85% specificity, 50% positive predictive value and 94% negative predictive value in predicting Crohn's disease relapse in the next six months.
In the 1-year follow-up, faecal alpha-antitrypsin clearance values were significantly higher at 12 months than at baseline and at six months.
Faecal alpha-antitrypsin clearance was higher in patients with raised C-reactive protein.
European Journal of Gastroenterology and Hepatology 2003;15:3:261-256.
"Fecal alpha1-antitrypsin clearance as a marker of clinical relapse in patients with Crohn's disease of the distal ileum"
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