Association between serum leucine-rich alpha-2-glycoprotein levels and characteristic enteroclysis findings in small intestinal Crohn’s disease

Abstract Introduction Enteroclysis provides a whole picture of mucosal and wall-structural information that is advantageous in assessing small intestinal Crohn’s disease (CD). Leucine-rich alpha-2-glycoprotein (LRG) is an acute-phase protein that has been shown to be increased in active CD. We sought to explore the association of LRG with the presence of typical CD findings in enteroclysis. Methods Patients with small intestinal CD whose serum LRG and C-reactive protein (CRP) were measured within 30 days before or after enteroclysis were selected, and were categorized by the presence of longitudinal ulcer, cobblestone appearance, and stricture/narrowing. Levels of LRG were compared by the type and the extent of lesions. Detection performances of LRG and CRP were compared for the presence of each type of lesion. Results Serum LRG levels were significantly higher in patients who had enteroclysis findings than patients with no findings (23.5 ± 9.2 vs. 12.8 ± 3.0 μg/dL, P < .00001). The level of LRG was not affected by disease extent or history of bowel resection. LRG over 16.3 μg/dL had good detection accuracy for the presence of CD lesions with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval: 0.75-0.95). The association of LRG with the presence of CD-specific lesions was significantly higher than CRP, especially for the presence of stricture/narrowing (AUC: 0.82 vs. 0.67, P = .005) and longitudinal ulcer (AUC: 0.93 vs. 0.80, P = .017). Conclusion Elevation of serum LRG is associated with the presence of typical CD lesions in the small intestine that may be found in entericlysis.