Abstract
The presence of a certain degree of inflammation in the gut wall is now accepted in irritable bowel syndrome (IBS). Fecal calprotectin is considered to be a reliable test for detecting intestinal inflammation. Our aim was to assess the presence of inflammation in postinfectious IBS (PI-IBS), compared with non-postinfectious IBS (NPI-IBS). A secondary objective was to determine the usefulness of a rapid fecal calprotectin test in inflammatory bowel diseases (IBD). This was a cross-sectional study. Patients with IBS and IBD at a single tertiary gastroenterology center were prospectively included in this study. 116 patients with Rome III IBS score (76 females; 48 ± 12 years) were investigated; 24 patients (15 females) had PI-IBS. Intestinal inflammation was assessed using the semiquantitative fecal calprotectin test. The results were expressed as T1, T2 or T3 according to the severity of inflammation (< 15 μg/g; 15-60 μg/g; > 60 μg/g). Using the same test, we evaluated 20 patients with IBD (12 males; 47 ± 13 years). None of the patients with IBS had a T2 or T3 positive test. Among PI-IBS patients, 33% had a T1 positive test. Among NPI-IBS patients, 9.8% had a T1 positive test, which was significantly different to PI-IBS. The calprotectin test was positive in all IBD patients: 80% with T3, 10% with T2 and 10% with T1. Using a semiquantitative test for fecal calprotectin, positive tests were more frequent in PI-IBS patients than in NPI-IBS patients.
Highlights
It is accepted that a certain degree of inflammation in the gut wall is present in irritable bowel syndrome.[1]
There are no data in the literature that have compared the levels of fecal calprotectin in postinfectious irritable bowel syndrome and non-postinfectious irritable bowel syndrome patients
The usefulness of calprotectin for detecting intestinal inflammation is accepted worldwide. Our study performed both on irritable bowel syndrome patients and on inflammatory bowel disease patients showed that even a simpler method such as a semiquantitative test for fecal calprotectin is useful for detecting intestinal inflammation
Summary
It is accepted that a certain degree of inflammation in the gut wall is present in irritable bowel syndrome.[1]. Increased levels of calprotectin indicate intestinal inflammation, but it is not disease-specific.[3]. Over the last few years, several studies have focused on evaluating the value of fecal calprotectin for detecting mucosal inflammation, especially in patients with inflammatory bowel disease, both in an active phase and in clinical remission. Patients with clinically quiescent inflammatory bowel disease have some degree of mucosal inflammation,[4] as proved by high levels of fecal calprotectin. Sipponen et al reported that there were high levels of calprotectin (up to 1000 mcg/g) in 13% of their inflammatory bowel disease patients who were in clinical remission.[5] Fecal calprotectin has prognostic value, such that the probability of remaining in clinical remission is higher when the fecal calprotectin level is low.[5] There is evidence that patients with mucosal healing seen through endoscopy have lower or normal fecal calprotectin levels.[6,7] Fecal calprotectin levels become increased in other organic disorders such as small bowel enteropathy, microscopic colitis, infectious diarrhea, segmental colitis associated with diverticulosis and colorectal cancer.[8]
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