IMMUNOLOGICAL PREDICTORS OF RECURRENCE IN PATIENTS WITH INFLAMMATORY BOWEL-DISEASE

The management of patients with inflammatory bowel disease is complicated by the poor correlation between symptoms and prognosis. This is due to the inconsistent and subjective nature of the symptoms of these diseases. Laboratory parameters which reflect the acute phase response offer an objective measure of disease activity and have been used in isolation as well as within clinical indices. The problem is that these parameters do not correlate very well with the indices of clinical activity. To predict disease recurrence it is presumed that an increase in disease activity, at the cellular level, precedes a clinical deterioration. An increase in acute phase proteins in the months before clinical recurrence confirms this supposition. The poor correlation between the acute phase proteins suggests that they may be reacting to different stimuli. Where single parameters are used the orosomucoid, C-reactive protein and alpha-1-antitrypsin levels are the best predictors of clinical relapse of Crohn's disease within the following three months, giving true positive rates of approximately 20% overall with a sensitivity of approximately 60%. The efficiency of these parameters improves in patients with Crohn's ileocolitis where rates of 27% and 63% are found. The less expensive erythrocyte sedimentation rate is almost as useful but is less specific. To improve the predictive ability of the acute phase proteins various indices have been proposed. These indices offer true positive rates of 29% to 77%. The wide range is probably due to patient selection, differing predictive periods and attack definitions in the orginal reports. In conclusion, the acute phases protein response can be used to predict disease recurrence but further refinement and verification is needed.