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Lewis Score Correlates More Closely with Fecal Calprotectin Than Capsule Endoscopy Crohn’s Disease Activity Index

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Abstract

Background

Small-bowel capsule endoscopy (SBCE) is an invaluable imaging method for the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) have been developed to standardize the reporting of small-bowel inflammation. Fecal calprotectin (FC) represents a highly reliable biomarker of intestinal inflammation.

Aim

To assess the performance of the two SBCE inflammation scoring systems by correlating them with FC. Furthermore, to define threshold levels for CECDAI.

Methods

Retrospective study; patients who underwent SBCE and had FC measurement shortly before or after SBCE. LS and CECDAI were calculated by a single reviewer and correlated [Spearman’s (r s )] with the FC results. Linear regression analysis was used to identify threshold levels for CECDAI.

Results

Forty-nine patients; three subgroups A, B and C (based on FC levels <100, 100–200, and ≥200 μg/g, respectively). LS appears to correlate with FC (r s  = 0.448, p = 0.0014), unlike CECDAI, which does not demonstrate significant correlation (r s  = 0.245, p = 0.089). Strongly positive correlation between FC and LS was observed in subgroup A (r s  = 0.68, p = 0.0047), while in subgroups B and C, neither LS nor CECDAI showed correlation with FC. Significant correlation between LS and CECDAI was demonstrated (r s  = 0. 6324, p < 0.0001). Linear regression analysis demonstrates that LS thresholds of 135 and 790 correspond with CECDAI levels of 3.8 and 5.8, respectively.

Conclusions

LS performs better than CECDAI in describing small-bowel inflammation, especially at FC levels of <100 μg/g. Furthermore, CECDAI levels of 3.8 and 5.8 seem to correspond to LS thresholds of 135 and 790, respectively.

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The authors report no conflicts of interest in relevance to this work. The authors alone are responsible for the content and writing of the paper.

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Authors and Affiliations

  1. Centre for Liver and Digestive Disorders, Endoscopy Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland, UK

    Anastasios Koulaouzidis, Sarah Douglas & John N. Plevris

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  1. Anastasios Koulaouzidis
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  2. Sarah Douglas
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  3. John N. Plevris
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Correspondence to Anastasios Koulaouzidis.

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Koulaouzidis, A., Douglas, S. & Plevris, J.N. Lewis Score Correlates More Closely with Fecal Calprotectin Than Capsule Endoscopy Crohn’s Disease Activity Index. Dig Dis Sci 57, 987–993 (2012). https://doi.org/10.1007/s10620-011-1956-8

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  • DOI: https://doi.org/10.1007/s10620-011-1956-8

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