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. 2023 Feb 8;13(4):626.
doi: 10.3390/diagnostics13040626.

Evaluation of Crohn's Disease Small-Bowel Mucosal Healing Using Capsule Endoscopy and Usefulness of Leucine-Rich α2-Glycoprotein

Hiroto Hiraga  1 , Daisuke Chinda  2 , Keisuke Hasui  1 , Yasuhisa Murai  1 , Takato Maeda  1 , Naoki Higuchi  1 , Kohei Ogasawara  1 , Sae Kudo  1 , Yohei Sawada  1 , Tetsuya Tatsuta  1 , Hidezumi Kikuchi  1 , Mami Ebina  2 , Noriko Hiraga  1 , Tatsuya Mikami  3 , Hirotake Sakuraba  1 , Shinsaku Fukuda  1
Affiliations

Evaluation of Crohn's Disease Small-Bowel Mucosal Healing Using Capsule Endoscopy and Usefulness of Leucine-Rich α2-Glycoprotein

Hiroto Hiraga et al. Diagnostics (Basel). .

Abstract

Recently, the importance of achieving clinical and deep remissions with mucosal healing (MH) has been demonstrated as a therapeutic goal to avoid Crohn's disease (CD) surgical operations. Although ileocolonoscopy (CS) is considered the gold standard, there are increasing reports on the benefits of capsule endoscopy (CE) and serum leucine-rich α2-glycoprotein (LRG) for evaluating small-bowel lesions in CD. We evaluated the data of 20 patients with CD who underwent CE in our department between July 2020 and June 2021 and whose serum LRG level was measured within 2 months. Concerning the mean LRG value, there was no significant difference between the CS-MH and CS-non-MH groups. Conversely, the mean LRG level was 10.0 μg/mL in seven patients in the CE-MH group and 15.2 μg/mL in 11 patients in the CE-non-MH group with a significant difference between the two groups (p = 0.0025). This study's findings show that CE can sufficiently determine total MH in most cases, and LRG is useful for evaluating CD small-bowel MH because of its correlation with CE-MH. Furthermore, satisfying CS-MH criteria and a cut-off value of 13.4 μg/mL for LRG suggests its usefulness as a CD small-bowel MH marker, which could be incorporated into the treat-to-target strategy.

Keywords: Crohn’s disease; capsule endoscopy; leucine-rich α2-glycoprotein; mucosal healing; small-bowel.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study patient selection.
Figure 2
Figure 2
Connection between Crohn’s disease activity markers and mucosal healing in ileocolonoscopy. (a) CRP, (b) Alb, (c) LRG, (d) CDAI, (e) LS, and (f) CECDAI were determined in the CS-MH (n = 5) and CS-non-MH groups (n = 5); P-value is the result of comparing two groups by the two-tailed t-test. Abbreviations: CDAI: Crohn’s Disease Activity Index, Alb: blood albumin level, CRP: C-reactive protein, LRG: leucine-rich alpha-2 glycoprotein, LS: Lewis Score, CECDAI: Capsule Endoscopy Crohn’s Disease Activity Index, CS: ileocolonoscopy, MH: mucosal healing, CE: capsule endoscopy.
Figure 3
Figure 3
Connection between Crohn’s disease activity markers and mucosal healing in capsule endoscopy. (a) CRP, (b) Alb, (c) LRG, (d) CDAI, (e) LS, and (f) CECDAI were determined in the CE-MH group (n = 7) and CE-non-MH group (n = 11); P-value is the result of comparing two groups by the two-tailed t-test.
Figure 4
Figure 4
Correlations between the LRG levels and Crohn’s disease activity markers. The correlations between the LRG level and (a) LS, (b) CECDAI score, (c) CDAI score, (d) Alb level, and (e) CRP level were examined (n = 20); P-value is the result by Spearman’s correlation coefficient.
Figure 5
Figure 5
Correlation of CE scores with Crohn’s disease activity markers. The correlations between the LS and (a) CRP level, (b) Alb level, and (c) CDAI score was examined (n = 20). A correlation between the CECDAI score and (d) CRP level, (e) Alb level, and (f) CDAI score was examined (n = 20); P-value is the result by Spearman’s correlation coefficient.
Figure 6
Figure 6
The original pictures of CE findings. (a,b) Distal ileum: linear ulcers (green arrows).
See this image and copyright information in PMC

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