A study led by the CIBEREHD group at Hospital Germans Trias demonstrates for the first time how to reduce the number of colonoscopies and improve the follow-up of patients with Crohn’s disease

Specialists from the Digestive System Department at Hospital Germans Trias have conducted and published a unique study that represents a significant improvement in the monitoring and treatment of patients who have undergone surgery due to one of the main inflammatory bowel diseases: Crohn's disease.

The data indicate that approximately half of these patients ultimately require surgery to relieve their symptoms. The most common procedure is ileocaecal resection, which involves removing the end of the small intestine (the ileum), where it connects to the beginning of the large intestine (the colon). Six to twelve months after this surgery, patients undergo a follow-up colonoscopy. However, beyond this period, monitoring is usually limited to repeating colonoscopies if symptoms reappear. In fact, it is estimated that 8 out of 10 patients experience a recurrence within a year of surgery, as lesions are detected in the operated area despite the absence of symptoms.

Ultimately, the key to improving patient follow-up and treatment after the first annual colonoscopy lies in calprotectin. This protein, which can be easily measured in stool samples, has been identified in the study as a reliable indicator of inflammation and lesions in the affected area. Over several years, researchers prospectively monitored calprotectin levels in more than fifty patients. The study determined that if calprotectin levels exceeded 250 μg/g, a repeat stool test was conducted, while a colonoscopy was only necessary when levels exceeded 400 μg/g.

Eugeni Domènech, Head of the Digestive System Department at Hospital Germans Trias, and Míriam Mañosa, specialist in the department-both members of the Inflammatory Bowel Diseases Research Group (GReMII) at the Germans Trias i Pujol Research Institute (IGTP)-concluded that, since no lesions were detected in patients with consistently low calprotectin levels, "the regular analysis of this protein serves a dual purpose: it enables more frequent monitoring of patients through a simple and rapid stool test and, consequently, prevents the sometimes unnecessary repetition of invasive and uncomfortable procedures such as colonoscopies."

The study, published in the journal Digestive and Liver Disease, was led by the CIBEREHD research group on liver and digestive diseases, of which both Domènech and Mañosa are members. It also received support from specialists at Hospital de Bellvitge, including Jordi Guardiola, Head of the Digestive System Department, as well as experts from Hospital de Sant Pau.

The reliability of the study's findings has prompted the Digestive System Department at Hospital Germans Trias to adopt this approach for patient follow-up. This is further supported by the fact that this practice has recently been incorporated as a recommendation in European guidelines on inflammatory bowel diseases.

A Disease of Unknown Cause with Debilitating Symptoms

Crohn's disease is, along with ulcerative colitis, one of the most common inflammatory bowel diseases (IBD). These conditions are a group of chronic inflammatory disorders of unknown cause that affect the digestive system.

It is estimated that 1% of the population in Catalonia suffers from one of these two diseases, with Crohn's disease accounting for approximately half of the cases. At Hospital Germans Trias, around 2,000 patients with Crohn's disease or ulcerative colitis are monitored each year.

Crohn's disease, which primarily affects young adults, causes inflammation that damages the layers of the intestinal wall. The most common symptoms include frequent bowel movements, diarrhoea, urgency to use the toilet, rectal bleeding, abdominal pain, fever, loss of appetite, and weight loss. Additionally, during active disease periods, affected individuals may also experience fatigue, joint pain, and skin issues, symptoms that often lead to significant personal, social, and family life changes.

A colonoscopy is one of the primary diagnostic methods for inflammatory bowel diseases. It allows specialists to examine the inside of the large intestine and detect inflammation or bleeding. This procedure involves inserting a flexible tube, known as an endoscope, through the anus. The endoscope has a small camera at its tip and is advanced through the colon. The examination is performed under sedation and anaesthesia, and patients must empty their bowels beforehand, typically by taking a laxative preparation approximately six hours before the procedure.