Estudo da medida do volume de fluxo da arteria mesenterica superior e do teste da permeabilidade intestinal na avaliação da doença de Crohn em atividade e remissão

Abstract

Crohns disease (CD) is a condition characterized by chronic relapsing inflammation, with remission periods disrupted by periods of disease activity. Increased gut permeability plays an important role in disease etiopathogenesis, allowing antigen presentation to immune system and thus trigging or maintaining inflammatory process. Vascular changes are also evident, including neovascularization, congestion and reduced vascular resistance to blood flow. Assessment of disease activity is a major clinical problem, wich has implications for the treatment and the patient. The aim of this study is to evaluate measurement of superior mesenteric artery (SMA) blood flow with Doppler ultrasound (US) and permeability intestinal test in CD patients in activity and remission. Forty patients were submitted to both tests and separated in two groups, according Crohns Disease Activity Index (CDAI): 28 patients with quiescent disease made up group 1 and 12 patients with active disease made up group 2. In group 2, the flow volume values were significantly higher than those in group 1 (626ml/min versus 376ml/min; p=0,001) as were lactulose to manitol urinary excretion ratio (L/MR) (0,083 versus 0,27; p=0,02). SMA flow volume has a sensitivity of 83% and a specificity of 82% for the diagnosis of disease activity. For intestinal permeability test, these indexes were 100% and 39%, respectively. The Kappa agreement index of both exams were 0,37. Our results suggest that patients with active CD had increased SMA flow volume and L/MR than patients in remission; abnormal results of SMA flow volume and intestinal permeability test were associated with CD activity; SMA flow volume had a good performance in assessment of disease activity and intestinal permeability test had high sensibility but low specificity.