The Crohn’s Disease Activity Index (CDAI), which relies on patient symptoms to determine whether or not Crohn’s disease is active, may not reliably indicate whether a patient’s disease has returned after corrective surgery, according to a study.
According to Miguel Regueiro, M.D. (pictured), associate professor of medicine and co-director of the Inflammatory Bowel Disease Center at the University of Pittsburgh School of Medicine, the CDAI relies on patients reporting their symptoms to determine whether or not Crohn’s disease has recurred or gone into remission after surgery.
“The natural course of Crohn’s disease often is symptom-free,” explained Dr. Regueiro. “The disease can present silently. In fact, many patients with Crohn’s may have had disease for years without having symptoms. Similarly, after surgery, most patients feel quite well for many years. We have found that most patients with recurrent Crohn’s disease after surgery also do not have symptoms. This is a concern because many patients with post-surgical Crohn’s disease recurrence will ultimately need another surgery and if they cannot feel their disease, adequate treatment may not be started. Because of this, we need to look for objective evidence of the disease instead of relying on patients to report how they feel.”
The study sought to discover whether disease recurrence detected by endoscopy agreed with patient symptom reports. Twenty-four patients with Crohn’s disease were randomly assigned to a post-operative clinical trial that assessed disease recurrence. According to the results, half of the patients went into remission after surgery while the other half did not, and there was little or no relationship between the return of the disease and the symptoms patients reported.
“Because patient symptoms don’t indicate whether Crohn’s disease has returned, we need to change how we consider symptom-based care and begin utilizing objective evidence, such as endoscopy, to understand the course the disease takes in individual patients. This way, we can detect the disease early, begin the correct treatment, and potentially prevent future complications and the need for more surgery,” said Dr. Regueiro.
Crohn’s disease is a form of inflammatory bowel disease that usually affects the intestines. Symptoms can range from mild to severe, and include crampy abdominal pain, fatigue, unexplained weight loss, diarrhea, liver inflammation, and skin rash. Without proper treatment, Crohn’s can lead to bowel complications such as obstructions and infection, as well as problems outside of the intestines, like inflammation of the joints and vitamin deficiencies.
Illustration: University of Pittsburgh Medical Center.
University of Pittsburgh Schools of Health Sciences News Release (08/16/10)
Medical News Today (08/17/10)
Abstract (Inflammatory Bowel Diseases; (06/28/10))