In the Journals

Crohn’s disease activity index does not discern between Crohn’s, IBS

Patients with irritable bowel syndrome had similarly elevated scores on the Crohn’s disease activity index as patients with Crohn’s disease in a recent study.

In a prospective, cross-sectional cohort study, researchers evaluated and compared Crohn’s disease activity index (CDAI) scores of 44 patients with Crohn’s disease (CD) and 47 with IBS. Hematocrit, C-reactive protein (CRP) and erythrocyte sedimentation rate also were measured.

Patients with IBS had a higher mean CDAI score than CD patients (183 compared with 157; P=.1). The IBS group had higher abdominal pain (mean 1.7 vs. 0.8; P=.0007) and well-being subscores (1.2 vs. 0.8; P=.04) than CD patients, with a higher score indicating feeling worse. Among evaluable patients, mean CRP levels (6.8 vs. 2.0; P=.002) and hematocrit scores (35.9 vs. 23.0; P=.02) were higher in the CD group, while absolute hematocrit values did not differ (P=.8).

CDAI scores above 150 occurred in 51 cases and included 29 IBS patients (62% of patients with IBS). Thirty-two percent of IBS patients had a CDAI above 220, indicating moderate-to-severe disease. Among participants with scores over 150, pain subscores were higher in the IBS group (mean 2.4 vs. 1.4; P=.002), while the CD group (mean 8.4 vs. 1.8; P=.001) had higher CRP levels.

Adam S. Cheifetz, MD

Adam S. Cheifetz

“I think it will interest clinicians that the CDAI, which is the gold standard for defining clinical endpoints in Crohn’s disease clinical trials, is unable to discriminate between patients with Crohn’s and IBS,” researcher Adam S. Cheifetz, MD, director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center in Boston, told Healio.com. “Additionally, it should be noted that when patients present with abdominal pain and diarrhea, it is important to rule out noninflammatory conditions, such as IBS. With our newer, more aggressive treatment paradigms, it is important to objectively confirm active Crohn’s disease before making therapeutic decisions.”

Disclosure: Researcher A.S. Cheifetz served as a consultant for Janssen Pharmaceuticals, Abbott Laboratories, Prometheus Labs, Given Imaging and Warner Chilcott.

Patients with irritable bowel syndrome had similarly elevated scores on the Crohn’s disease activity index as patients with Crohn’s disease in a recent study.

In a prospective, cross-sectional cohort study, researchers evaluated and compared Crohn’s disease activity index (CDAI) scores of 44 patients with Crohn’s disease (CD) and 47 with IBS. Hematocrit, C-reactive protein (CRP) and erythrocyte sedimentation rate also were measured.

Patients with IBS had a higher mean CDAI score than CD patients (183 compared with 157; P=.1). The IBS group had higher abdominal pain (mean 1.7 vs. 0.8; P=.0007) and well-being subscores (1.2 vs. 0.8; P=.04) than CD patients, with a higher score indicating feeling worse. Among evaluable patients, mean CRP levels (6.8 vs. 2.0; P=.002) and hematocrit scores (35.9 vs. 23.0; P=.02) were higher in the CD group, while absolute hematocrit values did not differ (P=.8).

CDAI scores above 150 occurred in 51 cases and included 29 IBS patients (62% of patients with IBS). Thirty-two percent of IBS patients had a CDAI above 220, indicating moderate-to-severe disease. Among participants with scores over 150, pain subscores were higher in the IBS group (mean 2.4 vs. 1.4; P=.002), while the CD group (mean 8.4 vs. 1.8; P=.001) had higher CRP levels.

Adam S. Cheifetz, MD

Adam S. Cheifetz

“I think it will interest clinicians that the CDAI, which is the gold standard for defining clinical endpoints in Crohn’s disease clinical trials, is unable to discriminate between patients with Crohn’s and IBS,” researcher Adam S. Cheifetz, MD, director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center in Boston, told Healio.com. “Additionally, it should be noted that when patients present with abdominal pain and diarrhea, it is important to rule out noninflammatory conditions, such as IBS. With our newer, more aggressive treatment paradigms, it is important to objectively confirm active Crohn’s disease before making therapeutic decisions.”

Disclosure: Researcher A.S. Cheifetz served as a consultant for Janssen Pharmaceuticals, Abbott Laboratories, Prometheus Labs, Given Imaging and Warner Chilcott.