The Usefulness of Fecal Calprotectin in Diagnosis and Follow-up of Intestinal Tuberculosis: Prospective Multicenter Study

Abstract

Introduction: Intestinal tuberculosis is one of the common extrapulmonary tuberculosis in Korea. Its diagnosis and follow-up study depends mainly on colonoscopy which is relatively invasive. And also it may be difficult to differentiate from other inflammatory diseases like Crohn's disease when expressed in an atypical form. We aimed to evaluate the usefulness of fecal calprotectin that is a non-invasive inflammatory marker in diagnosis and follow-up of intestinal tuberculosis Methods: Patients were prospectively recruited in five Catholic medical centers from 2015 to 2016. Endoscopic, laboratory and histological findings were investigated. Fecal calprotectin level was measured before and 2 months after administration of anti-tuberculosis drugs. Results: Twenty-three patients were consecutively enrolled and diagnosed with intestinal tuberculosis probably or definitely. Three cases were not followed up and 3 cases were finally diagnosed with Crohn's disease (Figure 1). Seventeen patients (mean age 52.8 years, 3 men) were analyzed. Fecal calprotectin level was significantly decreased after anti-tuberculosis therapy for 2months (206.84 vs 56.65 mg/Kg, P=0.006). Fecal calprotectin levels of 3 patients who were finally diagnosed with Crohn's disease were >2000, >2000, and 1542 mg/kg respectively, which were significantly higher than those of patients with intestinal tuberculosis. Conclusion: The decrease of fecal calprotectin level after anti-tuberculosis therapy is the important indicator of diagnosis and therapeutic response in intestinal tuberculosis. Fecal calprotectin value above 1000 mg/kg before treatment should be suspected of other inflammatory bowel diseases.