(18-05-12) Lewis score correlates more closely with fecal calprotectin than Capsule Endoscopy Crohn's Disease Activity Index.

Koulaouzidis A, Douglas S, Plevris JN.
Source
Centre for Liver and Digestive Disorders, Endoscopy Unit, The Royal Infirmary
of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland, UK.
[email protected]
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 ??g/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 ??g/g. Furthermore, CECDAI levels of 3.8 and 5.8
seem to correspond to LS thresholds of 135 and 790, respectively.

Source: Dig Dis Sci. 2012 Apr;57(4):987-93. Epub 2011 Nov 6.

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