Immune Fecal Occult Blood Test Is Superior to Systemic Inflammatory Markers for Predicting Mucosal Healing Among Patients With Ulcerative Colitis

Abstract

Ulcerative colitis (UC) has emerged in the Asia-Pacific region over the past two decades. The treatment goal for UC has shifted from symptom relief to endoscopic remission. Endoscopy is the gold standard for the diagnosis of mucosal healing; however, it is expensive and invasive. Therefore, the present study evaluated the use of the immune fecal occult blood test (iFOBT) result as a marker to predict mucosal healing among patients with UC. A total of 54 patients with UC were retrospectively enrolled from the electronic clinical database of Changhua Christian Hospital, Taiwan, from January 2019 to July 2019. Stool samples for iFOBT, blood samples for analysis (hemoglobin level, C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR], and albumin level), and Mayo disease activity scores were reviewed and analyzed. Colonic mucosa was assessed using the Mayo endoscopic subscore. The mean age of the patients was 46.67 years, and 65% of the patients were male. The disease distribution was as follows: E1 (24.07%), E2 (37.04%), and E3 (37.89%). Complete mucosal healing (CMH) occurred in 25.9% of the patients. Patients with and without mucosal healing were compared, and they were of a similar age, with a comparable white blood cell count, hemoglobin level, CRP level, ESR, and drug use. Patients with CMH exhibited a lower platelet count (226,000/μL vs. 287,000/μL, p = 0.033), iFOBT value (7.0 ng/mL vs. 105 ng/mL, p = 0.001), neutrophil-to-lymphocyte ratio (1.93 vs. 2.34, p = 0.004), and partial Mayo score (1 vs. 3, p = 0.001). Predictive cutoff values were assessed using receiver operating characteristic analysis, and the iFOBT exhibited the highest area under the curve than the other parameters examined. Using the iFOBT criterion of ≤ 30 ng/mL, the sensitivity and specificity were 100% and 69.44%, respectively, for the prediction of CMH. The iFOBT value may be a useful marker to predict endoscopic healing of colon mucosa among patients with UC in daily clinical practice.