Correlation between faecal calprotectin and magnetic resonance imaging (MRI) in the evaluation of inflammatory pattern in Crohn's disease.

BACKGROUND: Calprotectin, a major cytosolic protein of neutrophils, is increased in inflammatory bowel disease (IBD) and may be considered a suitable marker of intestinal inflammation. Abdominal MRI is becoming more frequently used for the evaluation of IBD patients. Aim of this study was to investigate the role of MRI in IBD for the assessment of disease activity in comparison with faecal calprotectin levels. PATIENTS AND METHODS: Twenty-four consecutive hospitalized pts (12 F, 12 M, median age: 56; range: 22-77) with a proven diagnosis of CD were studied. At the time of the MRI examination, pts provided a single stool sample for calprotectin measurement. Calprotectin was measured by ELISA (Calprest(R)). Pathological values were considered more than 50 microg/g. All pts underwent MRI, performed at 1.5 T, with HASTE T2w with and without fat-saturation, FLASH T1w fat-saturated sequences pre and post iv injection of 0.1 ml/kg of Gadolinium. Presence, degree and length of wall inflammation were evaluated. The MRI degree of wall inflammation was graded with a 0-3 scoring system (0=absent 1=light 2=moderate 3=severe) by considering findings observed on T1 post Gd and T2 fat-suppressed images, as well as the degree of wall thickness. The length of extension was considered as less than 15 cm, between 15 cm and 30 cm, or more than 30 cm. Spearman's correlation coefficient was used to evaluated differences in calprotectin levels among the groups obtained by MRI findings. RESULTS: Grade 0 MRI was found in 1 pt with a faecal calprotectin measurement of 206.25 microg/g; Grade 1 MRI was found in 4 pts with a median faecal calprotectin of 100 microg/g (5-325); Grade 2 MRI was found in 10 pts with a median faecal calprotectin of 243.75 microg/g (7.5-606.25); Grade 3 MRI was found in 9 pts with a median faecal calprotectin of 1012.5 microg/g (30-1268.8). A trend of positive correlation was therefore found between MRI scores of activity and calprotectin levels (p less than 0.0001) and between MRI scores of thickening of intestinal involvement and calprotectin levels (p = 0.005). No apparent correlation was observed between faecal calprotectin concentration and length. CONCLUSIONS: Data presenting show that faecal calprotectin levels well correlate with the degree of mucosal inflammation are in agreement with previous studies. Considering the correlation obtained between calprotectin level and MRI findings, we believe that MRI is helpful in assessing and monitoring the degree of disease in Crohn's disease.

Detection of anti-endomysial and anti-tissue transglutaminase autoantibodies in media following culture of oral biopsies from patients with untreated coeliac disease.

BACKGROUND AND AIMS: Coeliac disease is an autoimmune disorder characterised by high levels of anti-endomysial and anti-tissue transglutaminase autoantibodies in sera and media of cultured intestinal mucosa biopsies from affected patients. In this study, we wished to investigate whether anti-endomysial and anti-tissue transglutaminase antibodies can also be detected in culture media of oral mucosa specimens, and whether the mouth can be used as an area of immunological testing for coeliac disease. METHODS: Small intestine and cheek biopsy samples taken from 16 patients with active coeliac disease and from 11 controls were cultured in vitro for 48 h at 37 degrees C in presence of medium alone. Anti-endomysial and anti-tissue transglutaminase were detected in sera and in supernatants of these cultured biopsy samples by indirect immunofluorescence and enzyme immunoassay (EIA), respectively. RESULTS: Anti-endomysial and anti-tissue transglutaminase were positive in sera of 15/16 coeliac disease patients. Culture media of intestinal mucosa samples from 14/16 coeliac disease patients were anti-endomysial positive, while the same antibodies were positive in supernatants of cultured oral mucosa samples from 15/16 coeliac disease patients. Anti-tissue transglutaminase were positive in both intestinal and oral culture media of 15/16 coeliac disease patients. Neither anti-endomysial nor anti-tissue transglutaminase were found in sera or in culture supernatants of both intestinal and oral biopsy samples from 11 controls. CONCLUSIONS: Our study suggests a new immunological site to detect the pathognomonic autoantibodies of coeliac disease and confirms that the mouth is involved in this illness.