Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom.
J Gastrointestin Liver Dis. 2009 Mar;18(1):23-6.
BACKGROUND & AIMS: Elevated serum chromogranin A (CgA) levels have been reported co-incidentally in a small group of irritable bowel syndrome (IBS) patients (n=19). Our aim was to ascertain the prevalence of elevated CgA in diarrhoea predominant Rome II IBS (D-IBS) patients and investigate if this could be a marker for octreotide therapy.
Patients with Rome II D-IBS were recruited prospectively and investigated as per British Society Guidelines including serial CgA levels (u/l). Patients with refractory symptoms and elevated CgA were considered for further investigation + or - octreotide therapy.
219 patients were recruited (68% females, mean age 45 years). 81% (n=177) of IBS patients had normal CgA levels (0-20u/l). Whilst 12.3% (n=27) had values between 20-60u/l, 6.8% (n=15) had CgA levels >60u/l; 96% (26/27) with initial CgA level of 20-60u/l had repeated CgA levels which normalised. One patient (3.7%) had a gastric adenocarcinoma. In the 15 patients with elevated CgA levels >60u/l, 8 normalised on repeated testing. In the other 7, there were no cases of carcinoid, n=1 gastric leiomyoma, n=1 rectal tumour and 4 patients had persistently elevated CgA levels but with improvement of symptoms. In one patient, octreotide was commenced which resulted in normalisation of CgA and symptoms.
CgA levels appear to be transiently elevated in D-IBS. Future work assessing CgA in patients with refractory D-IBS may potentially identify individuals who will benefit from octreotide therapy.
有报道称，在一小部分肠易激综合征（IBS）患者（n=19）中偶然发现血清嗜铬粒蛋白 A（CgA）水平升高。我们的目的是确定腹泻为主型罗马 II 肠易激综合征（D-IBS）患者中 CgA 升高的患病率，并探讨其是否可作为奥曲肽治疗的标志物。
前瞻性招募符合罗马 II 型 D-IBS 标准的患者，并按照英国协会指南进行调查，包括连续 CgA 水平（u/l）。对于有难治性症状和 CgA 升高的患者，考虑进一步进行检查+或-奥曲肽治疗。
共招募 219 例患者（68%为女性，平均年龄 45 岁）。12.3%（n=27）的患者 CgA 值在 20-60u/l 之间，6.8%（n=15）的患者 CgA 值>60u/l；96%（26/27）的患者初始 CgA 值在 20-60u/l 之间，重复检测后 CgA 值正常化。1 例患者（3.7%）患有胃腺癌。在 15 例 CgA 值升高>60u/l 的患者中，8 例重复检测结果正常化。其余 7 例中，无类癌病例，1 例胃平滑肌瘤，1 例直肠肿瘤，4 例患者 CgA 值持续升高，但症状改善。1 例患者开始使用奥曲肽治疗，结果 CgA 和症状正常化。
CgA 水平在 D-IBS 中似乎短暂升高。未来评估难治性 D-IBS 患者 CgA 的研究可能会发现受益于奥曲肽治疗的个体。
