The Role of Serum Bio-Markers in Predicting Small Bowel Pathology in Crohn`s Disease Patients

Abstract

Background: Computed tomography enterography (CTE) is a useful modality in the evaluation of small bowel (SB) crohn`s disease (CD) as it can provide assessment of disease activity, extramural abnormalities and SB complications. This procedure however utilises radiation exposure. The aim of this retrospective study was to determine the clinical indications and findings on CTE and to determine if serum bio-markers (CRP, ESR, platelet count and anaemia) can predict significant pathologies.

Method: This was a retrospective analysis where 50 patients above the age of 18 with CD who had CTE between October 2013 and February 2015 were identified. The clinical indications, serum bio-markers and CTE findings in these patients were analysed.

Results: The main indications for CTE were abdominal pain/discomfort and/or symptoms suggestive of SB obstruction. 26% of CD patients had active inflammation, 36% had a SB stricture and 4% had active inflammation with stricturing and fistulating disease. All the patients with a completely normal CTE did not have a raised bio-marker whist 76.9% of patients with active inflammation had one or more positive bio-markers. Additional findings were active colitis (8%), splenomegaly (4%), aortitis (2%) and had sacroileitis (2%). In these patients, 75% had a positive bio-marker. In patients with positive findings, the Erythrocyte Sedimentation Rate (ESR) was the most common marker of inflammation.

Conclusion: CTE is an important tool in management of patients with CD however, in the presence of normal biomarkers, clinicians should question the need for CTE and thus decrease exposure of CD patients to ionising radiation.