Abstract
Inflammatory bowel disease (IBD) should be suspected in any patient presenting with chronic or recurrent abdominal pain and diarrhoea. Current guidelines suggest performing invasive endoscopy with histological sampling for further diagnosis. Measuring calprotectin, a neutrophilic protein, in faeces has been proposed as a surrogate marker of intestinal inflammation. Calprotectin values have been shown to reliably differentiate between IBD and non-organic disease in symptomatic patients and, when elevated, warrant early endoscopic investigation to rule out IBD and other organic pathologies. Endoscopy with histological sampling is also used to evaluate disease activity and here, too, faecal calprotectin values seem to correlate well. In a number of studies, faecal calprotectin values have consistently shown to better assess mucosal inflammation than clinical indices and serum markers. Calprotectin's advantage of non-invasive monitoring of disease activity is especially beneficial when considering the dynamics of repeated measurements. Mucosal healing (MH) has been associated with sustained clinical remission, reduced rates of hospitalisation and of surgical resection, both in Crohn's disease and ulcerative colitis patients. Elevated faecal calprotectin levels in patients in clinical remission are associated with increased risk of disease relapse within 12 months follow-up. In most clinically quiescent IBD, residual mucosal inflammation is still present; it appears that faecal calprotectin can detect subclinical mucosal inflammation and thus might identify patients at risk for relapse. In summary, measuring faecal calprotectin can be highly useful in the diagnosis and disease management of patients with IBD and could help predict disease course.
Highlights
Inflammatory bowel disease (IBD) is a life-long disorder that includes two major forms of chronic intestinal inflammation: Ulcerative colitis (UC) and Crohn’s disease (CD)(table 1)
Calprotectin values have been shown to reliably differentiate between IBD and non-organic disease in symptomatic patients and, when elevated, warrant early endoscopic investigation to rule out IBD and other organic pathologies
Elevated faecal calprotectin levels in patients in clinical remission are associated with increased risk of disease relapse within 12 months follow-up
Summary
Inflammatory bowel disease (IBD) is a life-long disorder that includes two major forms of chronic intestinal inflammation: Ulcerative colitis (UC) and Crohn’s disease (CD)(table 1). The clinical presentation of IBD depends on the disease location and its extent and can be inconsistent, showing symptoms that overlap with both disorders. Some 10% of patients have CD of the small bowel and up to 15% may have penetrating lesions (fistulae, phlegmonous disease, or abcesses) at the time of diagnosis [14]. Extraintestinal manifestations in IBD are common and occur in up to 43% of patients [15,16,17,18]. This might be an over-estimation that arises from high-volume referral centre data. Community studies suggest a lower prevalence of extraintestinal manifestations [17]. Guidelines for the treatment of IBD have been published [19,20,21,22,23]
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