Fecal Calprotectin Levels for the Ethiological Diagnosis in Brazilian Patients With Gastrointestinal Symptoms

Abstract

Introduction: Determination of fecal calprotectin (FC) can provide an important guidance for the physician, also in primary care, in the differential diagnosis of gastrointestinal disorders mainly between inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). The aims of the present study were to prospectively investigate, in Brazilian adults with gastrointestinal complaints, the value of FC as a biomarker for the differential diagnosis between functional and organic disorders and to correlate the concentrations with the activity of IBD. Methods: The study included consecutive patients who had gastrointestinal complaints in which the measurement levels of FC were recommended. FC were measured using a Bühlmann (Basel, Switzerland) ELISA kit. Results: A total of 270 patients were included in the study, with median age of 39 years (range, 18-78 years). After clinical and laboratorial evaluation and considering the final diagnosis, patients were allocated into the following groups: a) IBS group: 154 patients (102 female and 52 male subjects), b) IBD group: 112 patients; 73 with Crohn’s disease (CD); 38 female and 35 male patients; 52.1% (38/73) presented active disease, and 47.9% (35/73) had disease in remission and 39 patients with ulcerative colitis (UC);19 female and 20 male patients; 48.7% (19/39) classified with active disease and 49.3% (20/39) with disease in remission. A significant difference (p<0.001) was observed between the median value of FC in IBS group that was 50.5 μg/g (IQR=16-294 μg/g); 405 μg/g (IQR=29-1980 μg/g) in CD patients and 457 μg/g (IQR=25-1430 μg/g) in UC patients. No difference was observed between the values found in the patients with CD and UC. Levels of FC were significantly lower in patients with IBD in remission when compared with active disease (p<0.001). Conclusion: The present study showed that the determination of FC assists to differentiate between active and inactive IBD and between IBD and IBS. Additionally, it may be used as a guide to classify the activity of the disease, monitor the treatment, predict relapses, and suggest if the clinical symptoms are from the basic disease or from functional comorbidity.Figure 1: Fecal calprotectin in the studied groups.