27 research outputs found
Instructions for Authors
Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD
Veranderingen in de behandeling van ziekte van Crohn*:Minder ziekenhuisopnames, operaties en gebruik van glucocorticoïden
Is there an added value of faecal calprotectin and haemoglobin in the diagnostic work-up for primary care patients suspected of significant colorectal disease? A cross-sectional diagnostic study
Background The majority of primary care patients referred for bowel endoscopy do not have significant colorectal disease (SCD), and are – in hindsight – unnecessarily exposed to a small but realistic risk of severe endoscopy-associated complications. We developed a diagnostic strategy to better exclude SCD in these patients and evaluated the value of adding a faecal calprotectin point-of-care (POC) and/or a POC faecal immunochemical test for haemoglobin (FIT) to routine clinical information. Methods We used data from a prospective diagnostic study in SCD-suspected patients from 266 Dutch primary care practices referred for endoscopy to develop a diagnostic model for SCD with routine clinical information, which we extended with faecal calprotectin POC (quantitatively in μg/g faeces) and/or POC FIT results (qualitatively with a 6 μg/g faeces detection limit). We defined SCD as colorectal cancer (CRC), inflammatory bowel disease, diverticulitis, or advanced adenoma (>1 cm). Results Of 810 patients, 141 (17.4 %) had SCD. A diagnostic model with routine clinical data discriminated between patients with and without SCD with an area under the receiver operating characteristic curve (AUC) of 0.741 (95 % CI, 0.694–0.789). This AUC increased to 0.763 (95 % CI, 0.718–0.809; P = 0.078) when adding the calprotectin POC test, to 0.831 (95 % CI, 0.791–0.872; P < 0.001) when adding the POC FIT, and to 0.837 (95 % CI, 0.798–0.876; P < 0.001) upon combined extension. At a ≥ 5.0 % SCD probability threshold for endoscopy referral, 30.4 % of the patients tested negative based on this combined POC-tests extended model (95 % CI, 25.7–35.3 %), with 96.4 % negative predictive value (95 % CI, 93.1–98.2 %) and 93.7 % sensitivity (95 % CI, 88.2–96.8 %). Excluding the calprotectin POC test from this model still yielded 30.1 % test negatives (95 % CI, 24.7–35.6 %) and 96.0 % negative predictive value (95 % CI, 92.6–97.9 %), with 93.0 % sensitivity (95 % CI, 87.4–96.4 %). Conclusions FIT – and to a much lesser extent calprotectin – POC testing showed incremental value for SCD diagnosis beyond standard clinical information. A diagnostic strategy with routine clinical data and a POC FIT test may safely rule out SCD and prevent unnecessary endoscopy referral in approximately one third of SCD-suspected primary care patients
Application of the Rome III criteria is not likely to reduce the number of unnecessary referrals for colonoscopy in primary care
Published diagnostic models safely excluded colorectal cancer in an independent primary care validation study
OBJECTIVE: To validate published diagnostic models for their ability to safely reduce unnecessary endoscopy referrals in primary care patients suspected of significant colorectal disease. STUDY DESIGN AND SETTING: Following a systematic literature search, we independently validated the identified diagnostic models in a cross-sectional study of 810 Dutch primary care patients with persistent lower abdominal complaints referred for endoscopy. We estimated diagnostic accuracy measures for colorectal cancer (N=37) and significant colorectal disease (N=141; including colorectal cancer, inflammatory bowel disease, diverticulitis, or >1cm adenomas). RESULTS: We evaluated 18 models - 12 specific for colorectal cancer -, of which most were able to safely rule out colorectal cancer: the best model (NICE-1) prevented 59% of referrals (95% confidence interval (CI): 56-63%), with 96% sensitivity (95%CI: 83-100%), 100% negative predictive value (NPV; 95%CI: 99-100%), and an area under the receiver operating characteristics curve (AUC) of 0.86 (95%CI: 0.80-0.92). The models performed less for significant colorectal disease: the best model (Brazer) prevented 23% of referrals (95%CI: 20-26%), with 95% sensitivity (95%CI: 90-98%), 96% NPV (95%CI: 92-98%), and an AUC of 0.73 (95%CI: 0.69-0.78). CONCLUSION: Most models safely excluded colorectal cancer in many primary care patients with lower gastrointestinal complaints referred for endoscopy. Models performed less well for significant colorectal disease
Concordance in anti-OmpC and anti-I2 indicate the influence of genetic predisposition : results of a European study of twins with Crohn's disease
An adaptive immunological response to microbial antigens has been observed in Crohn's disease (CD). Intriguingly, this serological response precedes the diagnosis in some patients and has also been observed in healthy relatives. We aimed to determine whether genetic factors are implicated in this response in a CD twin cohort.
In total, 82 twin pairs (Leuven n = 13, Maastricht n = 8, A-rebro n = 61) took part: 81 pairs with CD (concordant monozygotic n = 16, discordant monozygotic n = 22, concordant dizygotic n = 3, discordant dizygotic n = 40) and 1 monozygotic pair with both CD and ulcerative colitis. Serology for Pseudomonas fluorescens-related protein (anti-I2), Escherichia coli outer membrane porin C (anti-OmpC), CBir1flagellin (anti-CBir1) and antibodies to oligomannan (anti-Saccharomyces cerevisiae antibody [ASCA]) was determined by standardized enzyme-linked immunoassay.
All markers were more often present in CD twins than in their healthy twin siblings. Using the intraclass correlation coefficient (ICC), agreements in concentrations of anti-OmpC and anti-I2 were observed in discordant monozygotic but not in discordant dizygotic twin pairs with CD (anti-OmpC, ICC 0.80 and -0.02, respectively) and (anti-I2, ICC 0.56 and 0.05, respectively). In contrast, no agreements were found in anti-CBir, immunoglobulin (Ig) G ASCA and ASCA IgA.
We show that anti-I2 and anti-CBir1 statuses have specificity for CD and confirm previous reported specificities for anti-OmpC and ASCA. Based on quantitative analyses and observed ICCs, genetics seems to predispose to the anti-OmpC and anti-I2 response but less to ASCA and anti-CBir1 responses