Fecal Calprotectin in Children Can Differentiate Between Different Gastrointestinal Diseases

Abstract

BACKGROUND: Calprotectin is a 36 kDa member of the S100 family of proteins. It is derived predominantly from neutrophils and has direct antimicrobial effects and a role within the innate immune response. Calprotectin is found in various body fluids in proportion to the degree of any existing inflammation and its concentration in feces is about 6 times that of plasma. Measurement of fecal calprotectin is a useful surrogate marker of gastrointestinal inflammation. It has a high negative predictive value in ruling out inflammatory bowel disease (IBD) in undiagnosed, symptomatic patients and high sensitivity for diagnosing the disease making it useful as a tool for prioritizing endoscopy. In patients with known IBD, fecal calprotectin can be a useful tool to assist management, providing evidence of relapse or mucosal healing to enable therapy to be intensified or reduced. AIM: The present study aimed to discuss the use of calprotectin for the diagnosis of IBD and some of the other ways in which the test may be useful in the management of gastroenterology patients. METHODS: A cross-sectional study on children with significant gastrointestinal diseases attending to pediatric department at Menoufia University, with a total number of 180 patients in addition to 30 normal children as control according to sample size calculation. The children are allocated into seven groups according to the final diagnosis to Group (1): 30 patients with IBD, Group (2): 20 patients with eosinophilic colitis, Group (3): 30 patients with Helicobacter pylori infection, Group (4): 40 patients with functional constipation, Group (5): 30 patients with cow milk allergy, Group (6): 30 patients with Celiac disease, and Group (7): 30 normal children as control. RESULTS: In cow milk protein allergic patients with marked GI presentation in the form of bloody diarrhea and/or abdominal distension, the mean fecal calprotectin (FC) was 1260 ± 625 μg/g. FC has decreased after 2−4 weeks of elimination of cow milk products to 420 ± 190 μg/g. Patient with inflammatory bowel disease had mean FC 4640 ± 850 μg/g, decreased after medical treatment and resolution of symptoms to 1360 ± 520 μg/g. In H. pylori infection detected by upper GI endoscopy and histopathology with positive stool antigen the mean FC was 78.9 ± 25.1 μg/g. Celiac disease patients had mean fecal calprotectin 456 ± 123 μg/g. Eosinophilic esophagitis had mean fecal calprotectin 4.2 ± 2.9 μg/g. Functional constipation patients had mean fecal calprotectin 23.6 ± 21.8 μg/g. Normal control children had mean fecal calprotectin 4.1 ± 6.9 μg/g. CONCLUSION: According to the results of previous studies, fecal calprotectin can be considered as a biomarker to differentiate between IBS and organic gastrointestinal disorders. However, due to the limitations of pre-analysis, a low fecal calprotectin concentration may not necessarily be considered as the reason for the absence of IBD.