Correlação entre dosagem de calprotectina fecal e marcadores de atividade inflamatória em pacientes com doença de Crohn de intestino delgado

• Ano de defesa: 2016
• Autor(a) principal: Argollo, Marjorie Costa [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300002n0h8
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Crohn's disease; Fecal calprotectin; Enterotomography; Inflammatory activity; Correlation; Doença de Crohn; Calprotectina fecal; Enterotomografia; Atividade inflamatória; Correlação
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4296290; http://repositorio.unifesp.br/handle/11600/46576

Introduction: Small bowel Crohn’s disease (CD) is a disorder of restricted onset and difficult to acess through out convencional ileocolonoscopy. Characterized as a cronic inflammatory process it can evolve with related complications as fistulas and stenosis, and with permanent tecidual damage and loss of function. Moreover, presents high morbidity and have a negative impact on quality of life. Since, it demands an early and agressive treatment along with a multidisciplinary approach. Management is grounded on deep sustained remission that includes symptomatic, laboratorial, radiologic, colonoscopic and histologic control. Clinical parameters may be subjective and it can not reflect real inflammation. Therefore, it was mandatory to search for more accurate and objective parameters to acess inflammatory activity in CD. Fecal calprotectin (FC) is described as a surrugate marker to evaluate inflammation of the colon. It remains controversy its utility in exclusive small bowel Crohn?s disease. Objective: Correlate fecal calprotectin and clinical activity acessed by Crohn?s Disease Activity Index (CDAI), laboratorial by C- reactive protein (CRP), and radiologic by enterotomography (entero-CT) in patients with small bowel CD. Methods: We included a total of 39 patients, 3 were excluded by fail in compliance thus the final analysis contemplated 36 individuals. At the first medical consultation after inclusion criteria requirements. Calculation of the CDAI was performed by the responsible researcher as blood and fecal samples were collected for CRP dosage and exclusion of infection of the gastrointestinal tract. Subsequently patients were conducted to schedule entero-CT and collect feces for FC dosage. Tests to evaluate the correlation between CDAI, levels of CRP and FC, and radiologic findings were applied (Sperman and Kendall t-b). Results: All patients (100%) presented with CDAI values below 150 wich means clinical remission, 29 (80%) with CRP levels above the normal limit (1,0mg/L), 31 (86%) with FC dosage above 150?g/gr. The mean value for CRP was 15,0mg/L and 1.003?g/gr for FC. At least 90% of the radiologic procedures by entero-CT reflected presence of inflammation activity that was classificated as mild (27,7%), moderate (45,45%) and severe (27,7%). Sensibility and especificity calculated for FC (>150?g/gr) were 90,5% and 66,7%, respectively. We demonstrated that there is a positive correlation between high levels of FC and inflammatory activity when evaluated by CRP and entero-CT, but not with CDAI. Our results are similar to those found in literature. Conclusions: FC and CRP can be used as reliable markers of inflammatory activity and serve as usefull tools in the management of patients with small bowel CD. Likewise, they can reduce the need for more invasive procedures to evaluate inflammation in that region