An assay has been found to reduce the number of colonoscopies and improve follow-up of patients with Crohn’s disease

Specialists from the Department of Gastroenterology at Hermanns Trias Hospital have conducted and published a unique study that significantly improves the control and treatment of patients who have undergone surgery for one of the major inflammatory bowel diseases: Crohn’s disease.

The findings suggest that approximately half of these patients eventually require surgery to relieve symptoms. The most common procedure is an ileocolonic resection, in which a section of the small intestine (ileum) is removed where it joins the beginning of the large intestine (colon).

Six to twelve months after this operation, patients undergo a repeat colonoscopy. However, after this period, follow-up is usually limited to repeat colonoscopies when new symptoms appear. It is estimated that 8 out of 10 patients have a recurrence within a year after surgery, because despite the absence of symptoms, foci of lesions are found in the operated area.

Ultimately, the key to improving patient follow-up and treatment after the first annual colonoscopy lies in calprotectin. This protein, which can be easily measured in stool samples, was identified in the study as a reliable indicator of inflammation and damage in the affected area. Researchers prospectively monitored calprotectin levels in more than fifty patients over several years. The study found that if calprotectin levels exceeded 250 µg/g, a repeat faecal analysis had to be performed, and colonoscopy was only necessary if levels exceeded 400 µg/g.

Regular analysis of this protein serves a dual purpose: it allows patients to be monitored more frequently with a simple and quick faecal analysis and therefore prevents the sometimes unnecessary repetition of invasive and inconvenient procedures such as colonoscopy.

The study, published in the journal Digestive and Liver Disease, was led by the CIBEREHD Liver and Digestive Disease Research Group.

The validity of the study’s findings prompted the Department of Gastroenterology at Germans Trias Hospital to adopt this approach for patient follow-up. Furthermore, this practice has recently been included as a recommendation in European guidelines on inflammatory bowel disease.

Illness of unknown cause with debilitating symptoms

Crohn’s disease, along with ulcerative colitis, is one of the most common inflammatory bowel diseases (IBD). These diseases are a group of chronic inflammatory diseases of unknown cause that affect the digestive system.

It is estimated that 1% of the population suffers from one of these two diseases, with Crohn’s disease accounting for approximately half of cases. Germans Trias Hospital sees about 2,000 patients with Crohn’s disease or ulcerative colitis each year.

Crohn’s disease, which mainly affects young people, causes inflammation that damages the layers of the intestinal wall. The most common symptoms include frequent bowel emptying, diarrhoea, urges to the toilet, rectal bleeding, abdominal pain, fever, loss of appetite and weight loss. In addition, during the active course of the disease, patients may experience fatigue, joint pain and skin problems – symptoms that often lead to significant changes in personal, social and family life.

Colonoscopy is one of the main methods for diagnosing inflammatory bowel disease. It allows specialists to look at the inside of the colon and detect inflammation or bleeding. The procedure involves inserting a flexible tube called an endoscope through the anus.

At the end of the endoscope is a small camera that is advanced through the colon. The examination is performed under sedation and anaesthesia, and patients must empty their bowels beforehand, usually by taking a laxative about six hours before the procedure.