Tests before and after EEN

[asadmom]

Hi there, I am getting my ducks in a row for my son's EEN (probably in a few weeks). Below are the tests that our GI doctors have ordered for us:

1) Tests ordered in the past (none currently) -
COMPLETE BLOOD COUNT WITH DIFFERENTIAL, SEDIMENTATION RATE, ALKALINE PHOSPHATASE, ALANINE TRANSAMINASE, ASPARTATE TRANSAMINASE, UREA NITROGEN, SERUM / PLASMA, BILIRUBIN, DIRECT, BILIRUBIN, TOTAL, CALCIUM, TOTAL, SERUM / PLASMA, C-REACTIVE PROTEIN, CREATININE, SERUM / PLASMA, IRON, % SATURATION AND TRANSFERRIN OR TIBC (DEPENDING ON THE LAB), FERRITIN, ALBUMIN, SERUM / PLASMA, VITAMIN D, 25-HYDROXY, AMYLASE, SERUM / PLASMA, LIPASE, GAMMA-GLUTAMYL TRANSPEPTIDASE, CALPROTECTIN, FECAL, VITAMIN B12, FOLATE, SERUM, GI PROFILE, STOOL, PCR (EXTERNAL LAB), VARICELLA ZOSTER VIRUS IGG, SERUM, ADALIMUMAB ACTIVITY (WITH NEUTRALIZING ANTIBODY)

2) Tests ordered (I can test these anytime) -
Vitamin A & E
Urinalysis with Microscopic
TSH Reflex FT4
Thiamine B1 Level
Zinc
Adalimumab Qnt with Reflex to Ab

3) Tests ordered (I can test these anytime) -
Lactulose Breath hydrogen test for SIBO
Capsule imaging


I was thinking of holding SIBO and capsule imaging (Part 3) until after his two-weeks of EEN and I can ask the docs to order Part 1 and do Part 1 and 2 before EEN and again after the EEN.

Seeking advice from those who have done EEN or PEN or some special diets... how did you monitor and am I thinking of this correctly?

 

[Pangolin]

The two gold standard tests for monitoring Crohn's are:

MRE, to monitor intestinal thickening, strictures, fistulas, and abscesses

Colonoscopy or capsule endoscopy to monitor the mucosal lining, to see ulceration or inflammation.

Next there are some less direct measures of inflammation:

CRP, which measures a protein associated with cell death

ESR, which measures how fast blood separates. People with more inflammation have more fibrinogen in their blood, which makes the blood separate faster

Fecal calprotectin, which measures a protein put into the stool by neutrophils which migrate to the gut lining during inflammation

The less direct a measure is, the more potential it has to not be an accurate reflection of what's really going on inside. For example, you could in theory have a medicine that specifically reduces CRP, which might look great at first, but does absolutely nothing to the actual medical problem.

Finally, you have all of the other tests that give you information about general health or specific things like iron levels. Sometimes you might want to target something specific as a result (eg iron supplementation), but usually these are going to improve or not depending on how the underlying Crohn's is going.