***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: In the European Cooperative Crohn 's Disease Study patients from 14 centers were included in whom diagnosis was made within 2 years before study entry on the basis of generally accepted radiological , endoscopical and /or histological criteria or a combination of all . Reasons for exclusion were : diagnosis older than 2 years in patients who did not require active treatment , age less than 18 years , duration of symptoms less than 3 months , presence of complications which potentially required emergency surgery . Data on clinical features were obtained in 633 patients , of whom 452 were eligible to participate in the study . In 110 patients r and omized to placebo  the natural course of Crohn 's disease was studied . Patients with ileocolonic involvement were younger than patients with either colonic or small intestinal involvement only . Classic ileitis terminalis was present in 14 % of the patients . 49 % of the patients had combined involvement of both the small and large intestine . 30 % of patients had only small intestinal involvement , and in 21 % colonic disease was present . Small intestinal involvement was associated with a significantly lower Crohn 's Disease Activity Index ( CDAI ) than other anatomical locations of the disease . Perianal disease was more often associated with colonic than with small intestinal involvement . 60 % of placebo patients with active disease at entry achieved at least a transient remission within the initial 5 months of study . After 2 years , 23 % of patients with active disease at entry and 68 % of patients with quiescent disease had reached or maintained a remission , respectively . By stepwise multiple linear regression analysis long duration of disease between diagnosis and r and omization , normal serum albumin and combined involvement of small intestine and colon were identified as predictors of a more favorable outcome of patients treated with placebo . In contrast , extensive small bowel disease , treatment with steroids and bowel resection prior to study entry correlated with a less favorable outcome . However , by life table analysis outcome of previously untreated and treated patients in the placebo group was similar OBJECTIVES : Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn 's disease ( SES-CD ) and noninvasive markers are scarce . The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin , C-reactive protein ( CRP ) , blood leukocytes , and the Crohn 's disease activity index ( CDAI ) . METHODS : Crohn 's disease patients undergoing complete ileocolonoscopy  were prospect ively enrolled and scored independently according to the SES-CD and the CDAI . SES-CD was defined as follows : inactive 0–3 ; mild 4–10 ; moderate 11–19 ; and high ≥20 . RESULTS : Values in CD patients ( n=140 ileocolonoscopies ) compared with controls ( n=43 ) are as follows : calprotectin , 334±322 vs. 18±5 μg/g ; CRP , 26±29 vs. 3±2 mg/l ; and blood leukocytes , 9.1±3.4 vs. 5.4±1.9 g/l ( all P<0.001 ) . The SES-CD correlated closest with calprotectin ( Spearman 's rank correlation coefficient r=0.75 ) , followed by CRP ( r=0.53 ) , blood leukocytes ( r=0.42 ) , and the CDAI ( r=0.38 ) . Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity ( 104±138 vs. 231±244 μg/g , P<0.001 ) , mild from moderate activity ( 231±244 vs. 395±256 μg/g , P=0.008 ) , and moderate from high activity ( 395±256 vs. 718±320 μg/g , P<0.001 ) . The overall accuracy for the detection of endoscopically active disease was 87 % for calprotectin ( cutoff 70 μg/g ) , 66 % for elevated CRP , 54 % for blood leukocytosis , and 40 % for the CDAI ≥150 . CONCLUSIONS : Fecal calprotectin correlated closest with SES-CD , followed by CRP , blood leukocytes , and the CDAI . Furthermore , fecal calprotectin was the only marker that reliably discriminated inactive from mild , moderate , and highly active disease , which underlines its usefulness for activity monitoring Introduction There are data suggesting that the diagnostic usefulness of faecal calprotectin ( FC ) may vary depending on the Crohn 's disease ( CD ) location . The aim of the study was to compare the diagnostic usefulness of FC in CD patients with different disease locations . Material and methods We prospect ively enrolled 120 CD patients in the study .  Disease activity was assessed by using Crohn 's Disease Activity Index ( CDAI ) , biochemical markers , and endoscopic and radiographic methods . Faecal calprotectin concentration was assessed in single stool sample s by using the ELISA method . Results Among all patients , 54 ( 45 % ) had ileocolonic CD location , 44 ( 36.5 % ) had isolated small bowel location , and 22 ( 18.5 % ) had colonic CD location .  FC correlated significantly with C-reactive protein concentration and endoscopic and radiographic activity among patients with isolated small bowel CD ( p = 0.03 , r = 0.32 ; p < 0.0001 , r = 0.78 ; p = 0.03 , r = 0.35 ; respectively ) and with C-reactive protein and endoscopic activity in isolated colonic CD ( p = 0.0009 , r = 0.7 ; p = 0.0002 , r = 0.78 ; respectively ) . CDAI and inflammatory biochemical markers did not correlate with endoscopic and radiographic assessment in small bowel CD . In patients with ileocolonic CD , FC correlated significantly with endoscopy ( p = 0.006 , r = 0.5 ) , radiographic assessment ( p = 0.04 , r = 0.3 ) , CDAI ( p = 0.0006 , r = 0.5 ) and the majority of biochemical markers . Conclusions Faecal calprotectin is a useful diagnostic marker in all CD patients . Although its usefulness in small bowel CD seems to be the lowest , it should be utilized particularly in this disease location because of the lack of other reliable , non-invasive diagnostic methods Abstract Objective . The utility of  fecal calprotectin ( fCal ) in small bowel Crohn 's disease ( CD ) remains to be clarified . The primary aim of this study was to determine levels of fCal  in CD restricted to the small bowel compared with CD affecting the colon , in patients undergoing their first diagnostic work-up . In addition , the study assessed the sensitivity and specificity of fCal in suspected CD . Material and methods . A total of 83 patients referred to gastroenterology out-patient clinic with suspected CD were included in this prospect i ve , blinded study , and fCal was measured during diagnostic work-up . Ileo-colonoscopy + capsule endoscopy/surgery ( n = 81 ) , ileo-colonoscopy + upper endoscopy ( n = 1 ) , and ileo-colonoscopy ( n = 1 ) served as gold st and ard for the presence and location of CD . Results . A total of 40 patients were diagnosed with CD : small bowel 13 , colonic 16 , and ileo-colonic 11 .  Levels of fCal were equal in patients with small bowel or colonic CD : median 890 mg/kg and 830 mg/kg , respectively ( p = 1.0 ) . With a 50 mg/kg cut-off , CD in the small intestine and colon was diagnosed with 92 % and 94 % sensitivities , respectively , and the overall sensitivity and specificity of fCal was 95 % and 56 % . In this cohort , CD was ruled out with a negative predictive value of 92 % . Conclusions . This is the first study to show that fCal is equally sensitive in colonic and small bowel CD . In patients suspected of CD , fCal is an effective marker to rule out this diagnosis and select patients for endoscopy Backgound : Patients being investigated for symptoms of abdominal pain , diarrhoea and or weight loss  often undergo small bowel radiology as part of their diagnostic workup mainly to exclude inflammatory bowel disease Objectives : Mucosal healing ( MH ) and deep remission ( DR ) are associated with improved outcomes in Crohn ’s disease ( CD ) . However , most of the current data pertain to colonic MH and DR , whereas the evidence regarding the prevalence and impact of small bowel ( SB ) MH is scarce . The aim of this study was to to evaluate the prevalence of SBMH and DR in quiescent SBCD . Methods : Patients with known SBCD in clinical remission ( CDAI<150 ) or with mild symptoms ( CDAI<220 ) were prospect ively recruited and underwent video capsule endoscopy after verification of SB patency . Inflammation was quantified using the Lewis score ( LS ) . SBMH was defined as LS<135 , whereas a significant inflammation was defined as LS>790 . Clinico-biomarker remission was defined as a combination of clinical remission and normal biomarkers . DR was defined as a combination of clinico-biomarker remission and MH . Results : Fifty-six patients with proven SB patency were enrolled ; 52 ( 92.9 % ) patients were in clinical remission and 21 ( 40.4 % ) in clinico-biomarker remission . SBMH was demonstrated in 8/52 ( 15.4 % ) of patients in clinical remission . Moderate-to-severe SB inflammation was demonstrated in 11/52 ( 21.1 % ) of patients in clinical remission and in 1/21 ( 4.7 % ) of patients in clinical and biomarker remission . Only 7/52 ( 13.5 % ) patients were in DR . Conclusions : SB inflammation is detected in the majority of CD patients in clinical and biomarker remission . SBMH and DR were rare and were independent of treatment modality . Our findings represent the true inflammatory burden in quiescent patients with SBCD BACKGROUND AND STUDY AIMS The Capsule Endoscopy Crohn 's Disease Activity Index ( CECDAI or Niv score ) was devised to measure mucosal disease activity using video capsule endoscopy ( VCE ) . The aim of the current study was to prospect ively vali date the use of the scoring system in daily practice . METHODS This was a multicenter , double-blind , prospect i ve , controlled study of VCE videos from 62 consecutive patients with isolated small-bowel Crohn 's disease . The CECDAI was design ed to evaluate three main parameters of Crohn 's disease : inflammation ( A ) , extent of disease ( B ) , and stricture ( C ) , in both the proximal and distal segments of the small bowel . The final score was calculated by adding the two segmental scores : CECDAI = ( [ A1 × B1 ] + C1 ) + ( [ A2 × B2 ] + C2 ) . Each examiner in every site interpreted 6 - 10 videos and calculated the CECDAI . The de-identified CD-ROMs were then coded and sent to the principal investigator for CECDAI calculation . RESULTS The cecum was reached in 72 % and 86 % of examinations , and proximal small-bowel involvement was found in 56 % and 62 % of the patients , according to the site investigators and principal investigator , respectively . Significant correlation was demonstrated between the calculation of the CECDAI by the individual site investigators and that performed by the principal investigator . Overall correlation between endoscopists from the different study centers was good , with r = 0.767 ( range 0.717 - 0.985 ; Kappa 0.66 ; P < 0.001 ) . There was no correlation between the CECDAI and the Crohn 's Disease Activity Index or the Inflammatory Bowel Disease Quality of Life Question naire or any of their components . CONCLUSION A new scoring system of mucosal injury in Crohn 's disease of the small intestine , the CECDAI , was vali date d. Its use in controlled trials and /or regular follow-up of these patients is advocated Background : Fecal Calprotectin ( FC ) is a vali date d screening test for intestinal inflammation in Crohn 's disease ( CD ) . The objective of the study was to prospect ively evaluate the limitations of FC for identifying CD in newly diagnosed untreated pediatric patients and to assess the association of FC levels with disease location and serum inflammatory markers . Methods : Consecutive children with new onset untreated CD participating in the ongoing ESPGHAN GROWTH CD study were evaluated at diagnosis for disease activity , extent , C‐reactive protein ( CRP ) , and FC . Results : In all , 60 children met the inclusion criteria ( mean age 12.6 ± 4.6 years , ) , 25 ( 42 % ) with mild disease , 17 ( 28 % ) moderate disease , and 18 ( 30 % ) severe disease . Twenty‐seven ( 45 % ) had small bowel disease only . Median FC levels did not differ between children with small bowel only ( 2198 & mgr;g/g interquartile range [ IQR ] 696–2400 ) and those with colonic involvement ( with or without small bowel disease ; 2400 
    Output:
    
SUMMARY AND CONCLUSION Fecal calprotectin has a significant diagnostic accuracy for the detection of small-bowel CD .
Our results suggest that in patients with suspected CD with calprotectin < 50 μg/g , the likelihood of positive diagnosis is very low