Abstract
To determine whether endoscopy can be used to diagnose remission and relapse of Crohn'sdisease (CD), the endoscopic findings of the ulcers of patients with CD were compared with the results of various laboratory tests including IOIBD scores, CDAI, ESR, and CRP. The subjects were 23 patients with CD who were treated with elemental diet therapy. Endoscopy was performed at the time of remission, which was diagnosed based on normalization of the laboratory tests described above. One month after normalization of the laboratory parameters, endoscopic examination showed that the ulcers of 18 patients revealed changes characteristic of the “healing stage”, while the ulcers of 5 patients showed changes characteristic of the “scarring stage”. In all 23 cases, it took several months before the ulcer completely healed and showed endoscopic findings characteristic of S2 stage scarring tissue. Further analyses of the relationship between the length of the remission period and endoscopic findings of the ulcer at the time of remission showed that the remission period of patients who had an S2-stage ulcer was 23.6±31.0 months, which was significantly longer than that of patients who had an-S1S2 stage ulcer (7.6±6.3 months) or an S1-stage ulcer (p<0.05, p<0.05) . These results suggest that actual healing of the ulcer (as evidenced by scarring on endoscopic examination) takes a much longer time than normalization of laboratory parameters. To prolong the remission period in CD, it is important to continue to treat patients even after the laboratory tests indicate remission, until endoscopy shows that the ulcer has reached the S2 stage. In the majority of patients in remission who subsequently suffer a relapse of the disease, changes in endoscopic findings preceded the changes in laboratory parameters. These results suggest that endoscopy is useful for detecting a relapse of CD and for determining the therapeutic strategy.
