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Subclinical Intestinal Inflammation in Patients with Crohn’s Disease Following Bowel Resection: A Smoldering Fire

  • 2009 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background/Aims

Fecal lactoferrin is the direct expression of intestinal inflammation in Crohn’s disease (CD). The aim of this study was to analyze the in vivo intimate correlation between intestinal and systemic inflammation in CD patients in clinical remission following bowel resection. The secondary end point was to evaluate the prognostic value of lactoferrin levels and serum cytokines in terms of need of surgery for recurrence in these patients.

Patients and Methods

Fecal lactoferrin and serum cytokine (interleukin (IL)-1β, IL-6, IL-12, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1) levels were assessed; hematological and biochemical investigations were carried out, and Crohn’s Disease Activity Index was evaluated in the 36 patients who had undergone bowel resection. The prognostic value of lactoferrin and cytokine levels in terms of surgical recurrence was assessed by re-calling patients after 24 months from the enrolment in the study.

Results

All patients, evaluated after a follow-up of 36 ± 5 months, were in clinical remission. Fecal lactoferrin levels were found to be significantly correlated with IL-6 (R = 0.431, p = 0.025) and C-reactive protein (CRP; R = 0.507, p = 0.007), while no correlation was observed between lactoferrin and IL-1β, IL-12, TNF-α, or TGF-β1. Reoperation for anastomotic recurrence tended to occur significantly more frequently in patients with higher IL-6 (p = 0.10).

Conclusions

Subclinical intestinal inflammation, expressed by fecal lactoferrin, seems to keep the systemic inflammation alive in CD patients through the IL-6-CRP cascade. IL-6 seems to be predictive of the outcome of CD patients undergoing surgery.

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Acknowledgments

We are very grateful to Mrs. M. Razzetti and Mr. F. Favaro (Department of Laboratory Medicine, University-Hospital of Padova, Italy) for their technical help in the detection of fecal lactoferrin and serum cytokine levels and to Mrs. Linda Moretti for her assistance in preparing the final version of this manuscript.

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Authors and Affiliations

  1. IV Unit of Surgery, Regional Hospital Cà Foncello, Piazza Ospedale 1, 31100, Treviso, Italy

    Cesare Ruffolo & Nicolò Bassi

  2. Clinica Chirurgica I, Department of Surgical and Gastroenterological Sciences, University of Padova, Padua, Italy

    Imerio Angriman

  3. Department of Surgery, Veneto Oncological Institute (IOV-IRCCS), Padua, Italy

    Marco Scarpa

  4. Department of Laboratory Medicine, University-Hospital of Padova, Padua, Italy

    Diego Faggian, Daniela Basso & Mario Plebani

  5. Gastroenterologia, Department of Surgical and Gastroenterological Sciences, University of Padova, Padua, Italy

    Renata D’Incà & Giacomo C. Sturniolo

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  1. Cesare Ruffolo
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  2. Marco Scarpa
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  3. Diego Faggian
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  4. Daniela Basso
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  5. Renata D’Incà
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  6. Mario Plebani
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  7. Giacomo C. Sturniolo
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  8. Nicolò Bassi
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  9. Imerio Angriman
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Correspondence to Cesare Ruffolo.

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Ruffolo, C., Scarpa, M., Faggian, D. et al. Subclinical Intestinal Inflammation in Patients with Crohn’s Disease Following Bowel Resection: A Smoldering Fire. J Gastrointest Surg 14, 24–31 (2010). https://doi.org/10.1007/s11605-009-1070-9

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  • DOI: https://doi.org/10.1007/s11605-009-1070-9

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