Monitoring disease activity

Monitoring disease activity includes:

• clinical - active disease may present with anorexia, malaise, fever, weight loss and tachycardia
  
  
• blood tests - raised ESR, CRP or platelet count, or a low albumin or anaemia, occur in active disease. However, a normal ESR and CRP do not imply inactive disease (1)
  
  
• radiological studies - ulcers, fistulae, or disease at a new site on barium studies indicate activity; MRI and CT can also have a role in diagnosis and monitoring of disease
  
  
• endoscopy -ulcers; ileocolonoscopy is considered the gold standard for the diagnosis and assessment of disease activity and extent (1)
  
  
• ultrasound - may reveal thickened bowel loops, an inflammatory mass or abscess.

Notes:

• endoscopy has always been the gold standard for assessing mucosal activity in Crohn's disease, but its use is limited by its invasiveness and its inability to examine the small intestine, proximal to the terminal ileum
  • enteroscopy and the less invasive small bowel capsule endoscopy enable the small bowel to be explored
• in addition to ultrasound; magnetic resonance and computed tomography are tools for monitoring and assessing inflammatory activity in the mucosa and the transmucosal extent of the disease, and for excluding extra-intestinal complications
• in addition to markers such as CRP; faecal biomarkers such as calprotectin and lactoferrin, are useful to identify the inflammatory burden of the disease and to identify patients requiring further investigations
  
  

Reference:

• D'Inca R, Caccaro R.Measuring disease activity in Crohn's disease: what is currently available to the clinician. Clin Exp Gastroenterol. 2014 May 20;7:151-61.
• Hara AK et al.Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy.Radiology. 2006 Jan;238(1):128-34.