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Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
There are no pathognomonic features associated with CD and a single gold standard for the diagnosis of CD is not available. Diagnosis is made clinically. It requires integration of history, physical examination, laboratory evaluation, and a combination of endoscopic, radiographic, and histologic findings documenting the focal, asymmetric, and transmural features of the disease (Table 11.1). The diagnosis is largely dependent on the finding of chronic discontinuous intestinal inflammation often with granulomatous changes [3, 4]. Fecal calprotectin may help differentiate inflammatory bowel disease from irritable bowel syndrome but is not validated in the pregnant population [1, 3]. Routine use of genetic testing or serologic markers is not indicated [1, 3]. A diagnosis of CD is rarely made for the first time during pregnancy [5].
Personalized Nutrition in Children with Crohn Disease
Published in Nilanjana Maulik, Personalized Nutrition as Medical Therapy for High-Risk Diseases, 2020
Monitoring during EEN should include repeat inflammatory markers (assuming that were elevated at diagnosis) to confirm improvements, serial measurement of patient’s weight and ascertainment of clinical improvements (resolution in symptoms). Follow-up measurement of fecal calprotectin may also be helpful.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
A stool sample can be tested for infections, malabsorption, and inflammation. Faecal calprotectin is a useful test that can help to differentiate between inflammatory bowel disease (IBD) and IBS [5]. It is released when there is inflammation in the bowels. A normal faecal calprotectin level (<50ug/g) is highly suggestive of non-inflammatory bowel conditions such as IBS, in the right clinical context. It can also be helpful to assess disease activity, response to treatment, and prediction of disease relapse in IBD [6].
Fecal calprotectin as a biomarker of intestinal inflammation in ICU patients with diarrhea – testing the pipette method against the collection pin and weighing methods
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Karoline Hardis, Sarah B. Johansen, Janne Eriksen, Kjeld Damgaard, Peter Derek Christian Leutscher, Soren Jepsen
In the recent years, there has been increasing focus on intestinal dysbiosis and inflammation as contributing disease factors in ICU patients with critical illness. In that context, fecal calprotectin is relevant to consider as a tool for assessment of intestinal inflammation in the ICU setting. The protein is released from activated neutrophil granulocytes, in addition to monocytes and macrophages, as part of the inflammatory response [8,9]. Hence, fecal calprotectin is a biomarker of inflammation in the gastrointestinal tract and is used for screening and monitoring of activity in inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis [10]. Fecal calprotectin values below 80 mg/kg are considered normal while values between 80 and 160 mg/kg represent a grey zone which may indicate a possible inflammatory response, whereas values above 160 mg/kg are stronger indicative of inflammation in the gastrointestinal tract [11].
Inflammatory bowel disease manifestations in spondyloarthritis: considerations for the clinician
Published in Expert Review of Clinical Immunology, 2021
Ennio Lubrano, Michele Maria Luchetti, Devis Benfaremo, Daniele Mauro, Francesco Ciccia, Fabio Massimo Perrotta
Finally, subclinical bowel inflammation in patients with SpA can be identified with calprotectin measured in the serum or in the stools. Cypers et al. [85] have found that the presence of subclinical microscopic colitis, in SpA patients, is associated with elevated serum calprotectin levels. Combined assessment of biomarkers may further increase the diagnostic accuracy: patients who had both CRP and calprotectin elevation had a frequency of bowel inflammation of 64% compared to 25% in patients who had low levels of these markers. Furthermore, in patients who had high levels of either serum calprotectin or CRP, the presence of bowel inflammation was significantly higher in SpA patients with high fecal calprotectin compared to those with low [85]. In a recent study, the assessment of fecal calprotectin as a useful biomarker to identify patients with subclinical bowel inflammation was confirmed. However, the specificity of fecal calprotectin may vary, since some reports showed that calprotectin levels may be influenced by non-steroidal anti-inflammatory drugs (NSAIDs) use, which is quite common in SpA patients [62,86].
Ixekizumab for the treatment of pediatric patients with moderate to severe plaque psoriasis
Published in Expert Opinion on Biological Therapy, 2021
Jennifer Clay Cather, Chaney T. Young, Melody S. Young, J. Christian Cather
It is important to note that during the IXORA-PEDS trial, there were 4 cases of treatment emergent Crohn’s disease and none had personal or family history of inflammatory bowel disease. If a child has psoriasis and signs or symptoms of inflammatory bowel disease, the most appropriate biologic option is adalimumab [88]; however, there is clinical data to support the use of ustekinumab as well [76,77]. Some helpful clinical clues of underlying pediatric Crohn’s disease (Table 5) include assessing for: weight loss, diarrhea, nocturnal bowel movements, and picky eating. A stool study for fecal calprotectin is sometimes helpful to differentiate irritable bowel syndrome from inflammatory bowel disease [89]. Clinical findings of persistent swelling of the upper and lower lips, gingivitis, cobble-stoning of oral mucosa, and mucosal tags should prompt referral to a gastroenterologist for evaluation of inflammatory bowel disease [90].