“Silent” Crohn’s Disease

David Binion comments on Silent Crohn’s Disease (CD) in a recent Gastroenterology & Hepatology: Here’s the link —Silent Crohn’s Disease

Key points:

  • “Approximately one-quarter of patients with active disease are asymptomatic.”  Some have termed these patients to have Silent CD.
  • Biomarkers including blood tests (eg. CRP), fecal markers (eg. Calprotectin), imaging and endoscopy can reveal active disease in many asymptomatic patients.  Conversely, about one-sixth of patients are “overreporters” who describe abdominal complaints without objective evidence of inflammation.
  • “CRP elevation represents a more significant threshold of mucosal damage compared with endoscopic assessment.”  “In our study, 37% of the silent Crohn’s disease cohort [with elevated CRP] at our center required hospitalization within 2 years compared with 7% of patients who felt well and had no elevation of CRP level.”

These findings reinforce the notion that mucosal healing in combination with symptoms is important at predicting long-term response to treatment.  A commonly-used physician global assessment may miss silent CD.

Bottomline: In those with “inactive” CD, obtaining a CRP (and possibly a fecal calprotectin) will improve detection of silent CD.

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