Intestinal permeability test as a predictor of clinical course in Crohn's disease

OBJECTIVE: The clinical course of Crohn's disease is often unpredictable. T he aim of this study was to select the most useful parameters able to predi ct clinical relapses. METHODS: One hundred-thirty Crohn's disease patients in clinical remission were followed every 4 months for 2 yr or until clinical relapse. Demographi c and clinical data were recorded and intestinal permeability (lactulose/ma nnitol [L/M] test) and biochemical tests (white blood cell count, erythrocy te sedimentation rate, C-reactive protein, alpha 1 acid glycoprotein, and s erum iron) were performed at study entry. A subgroup of 54 patients had cli nical follow-up and repeated tests every 4 months. RESULTS: Fifty-two patients (40%) relapsed during the 2-yr follow-up. A sig nificant correlation was found between relapse and gender (p = 0.030) but n ot between relapse and age, extent and type of disease, previous surgery, s r therapy. Increased L/M test (p = 0.0001) and decreased serum iron level ( p = 0.0057) were associated with clinical relapse. Time-dependent analysis, performed on patients receiving serial evaluation, showed that L/M test al teration was the only variable that could predict a relapse (RR 8.84, 95% c onfidence interval [CI] 1.41-53.37; p < 0.05). CONCLUSIONS: The L/M test identifies Crohn's disease patients in apparent r emission, but with a high risk of clinical relapse, better than clinical an d biochemical indices. Different treatment strategies might be suggested fo r this subgroup of patients. (C) 1999 by Am. Coll. of Gastroenterology.