As the partner of a Crohn’s patient I realize you don’t need a test to tell you’re feeling ill and that your quality of life is below any number on a test scale. But tests are helpful if you’re wondering when you’ll be feeling better after treatment; or if you’re attempting to get approval for a better treatment.
Types of Tests
There are several categories of tests. There are diagnostics, such as scoping, X-rays, blood tests, and biopsies to determine if you have Crohn’s. There are also tests like the Crohn’s Disease Activity Index that are used to calculate or quantify the seriousness of the disease, often for government agencies. There are also tests that monitor how your condition and/or treatment is affecting the ways you move through your daily life; are you feeling significantly better, for instance, after a year on Remicade? Some of these tests require biochemical tests while others don’t.
Crohn’s Disease Activity Index
The CDAI is a research tool that quantifies Crohn’s symptoms. While there are several forms, it was originally developed in 1976. Its scores are often used by governments for determining the eligibility of patients for restricted drugs such as Remicade. A typical calculator, as used by Medicare Australia consists of eight weighted variables, namely:
- Liquid stools e.g. cumulative total over last 7 days (number X 2)
- Abdominal pain e.g. cumulative total over last 7 days (0-3 X 5)
- General well-being e.g. cumulative total over last 7 days (1-4 X7)
- Extra intestinal e.g. arthritis, iritis, skin/mouth lesions, peri-anal disease, other fistula, fever (0-6 X 20)
- Anti-diarrhoeals e.g. Lomitil (value X 30)
- Abdominal mass (0-5 Value X 10)
- Haematocrit (Hct) or PCV e.g. from recent blood test (% value X 6)
- Current Weight (% value +/- standard)
Inflammatory Bowel Disease Questionnaire
The IBDQ is a 32-item test that examines the impact of Crohn’s disease on a patient’s bodily function, emotional state, functional abilities and social function. As Flintbox explains, it is “a validated and reliable quality of life questionnaire which as been used extensively in research and clinical trials since 1997.” Interviewer-administered and self-administered versions are available. Time recall is over the last two weeks. AG de Boer et al validated it in 1995 as “reliable and valid… in multicultural research setting.”
There are various versions. As discussed by Brian G. Feagan M.D. et al in using the test in 2007 to measure quality of life with infliximab therapy (e.g. Remicade) there generally are four dimensions, namely:
- bowel-related symptoms (e.g., loose stools, abdominal pain),
- systemic function (e.g., fatigue, sleep pattern),
- social function (e.g., ability to attend work and social events),
- and emotional status (e.g., anger, depression, irritability).
The responses for each question range from 1 to 7 with the score (32 to 224) the sum of the responses; the lower numbers indicates severe impairment. According to doctor Feagan, “patients in symptomatic remission usually have a score of 170 or greater.”
Harvey Bradshaw Index
This index was devised in 1980. As Gastro Training explains, it was designed “as a simpler version of the Crohn's disease activity index (CDAI) for data collection purposes. It consists of only clinical parameters: The first three items are scored for the previous day. The Harvey-Bradshaw index is far simpler to use than the CDAI and does not require biochemical tests. It measures:
- general well-being
- abdominal pain
- loose stools
- complications
This is a summary. As Bio Advance pointed out in its June 2011 Newsletter, “there may be other tests that your physician prefers or finds easier to interpret.”
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Sources:
- When Will I Start Feeling Better? Bio Advance Connect. June 2011.
- Medicare Australia
- Flintbox
- Brian G. Feagan, M.D., Walter Reinisch, M.D., Paul Rutgeerts, M.D., Ph.D., William J. Sandborn, M.D., Songkai Yan, M.S., Debra Eisenberg, M.S., Mohan Bala, Ph.D., Jewel Johanns, Ph.D., Allan Olson, M.D., and Stephen B. Hanauer, M.D. Infliximab Therapy on Quality of Life in Ulcerative Colitis Patients: Materials and Methods. The American Journal of Gastroenterology. 2007; 102(4):794-802.
- Gastro Training
- AG de Boer et al. Inflammatory Bowel Disease Questionnaire: cross-cultural adaptation and further validation. Eur J Gastroenterol Hepatol. Nov. 1995. pp. 1043-50. Online
James Gibson - James Gibson is a retired teacher and small business owner. He is a published writer and has a wide spectrum of interests.
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