Accuracy Of Fecal Calprotectin Research Articles

Single measurement of bowel wall thickness using intestinal ultrasonography in children with ulcerative colitis.

Endoscopic monitoring of disease activity in patients with ulcerative colitis (UC) is important. However, frequent colonoscopic examinations are difficult to perform because of their invasiveness, especially in children. Bowel wall thickness (BWT) measurement using intestinal ultrasonography and fecal calprotectin (FC) measurement are useful noninvasive evaluation methods. We retrospectively analyzed BWT and FC levels and evaluated the Mayo endoscopic subscore (MES) using colonoscopy in pediatric patients with UC during the same period. The BWT was evaluated using the maximum BWT (mBWT), which was the maximum value of each colonic BWT; the sum of BWT (sBWT), which was the sum of each colonic BWT; and the sum of the adjusted BWT (saBWT), which was corrected using sBWT. In 54 procedures from 40 patients, FC, mBWT, sBWT, and saBWT were significantly different between MES 0-1 and MES 2. The agreement between BWT and MES 2 was 193 out of 216 segments (89.4%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FC were 68.8%, 84.2%, 64.7%, 86.5%, and 79.6% respectively, while those of saBWT were 81.2%, 89.5%, 76.5%, 91.9%, 87.0%, respectively. BWT in each colonic segment, particularly saBWT, was more useful than FC for detecting moderate colonic inflammation (MES 2) in pediatric patients with UC. Therefore, intestinal ultrasonography may be helpful in the less invasive management of pediatric patients with UC.

Is Fecal Calprotectin a Useful Marker for Small Bowel Crohn Disease?

The identification of reliable non-invasive biomarkers of Crohn disease (CD) activity is crucial. Fecal calprotectin (FC) is the most promising one. We aimed to define whether its performance for isolated ileal CD could be as useful as for colonic and ileocolonic disease. Retrospective observational study of all pediatric patients affected with CD with FC and inflammatory blood markers performed within one week from an ileocolonoscopy or magnetic resonance enterography. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of FC >50 mcg/g were evaluated for isolated ileal CD (L1), colonic CD (L2) and ilecolonic CD (L3) using ilecolonoscopy and magnetic resonance enterography as the reference standard. The best FC cut-off for each disease location was evaluated using receiver operating characteristic curves. One-hundred seventy-six FC measurements from a total of 98 patients were collected (14.3% L1, 10.2% L2, 75.5% L3). The sensitivity and specificity of FC for L1 CD were 36% and 91%, respectively, compared to 93% and 75% for L2 and 70% and 95% for L3. An FC of 95 mg/kg was identified as the best cut off for identification of active isolated ileal disease, with a sensitivity of 77% and a specificity of 56% [area under the curve (confidence interval [CI] 0.56- 0.97) 0.77, P = 0.02]. With a sensitivity of 36%, FC alone does not accurately reflect isolated L1 disease activity. A significantly lower threshold should be applied for increasing its performance for isolated small bowel CD monitoring.

Diagnostic accuracy of faecal calprotectin in a symptom-based algorithm for early diagnosis of inflammatory bowel disease adjusting for differential verification bias using a Bayesian approach

Background Diagnostic delay in IBD is a major problem and diagnosis is frequently arrived when irreversible damage has already occurred. This study evaluated accuracy of faecal calprotectin (fCAL) integrated with diagnostic criteria for early diagnosis of IBD in a primary care setting. Methods General practitioners (GPs) were trained to recognize alarm symptoms for IBD classified as major and minor criteria. Fulfilment of one major or at least two minor criteria was followed by free fCAL testing and a visit by an IBD specialist and follow-up over 12 months. All patients with positive fCAL testing, i.e., ≥70 μg/g underwent colonoscopy. The diagnostic accuracy of fCAL was estimated after adjusting for differential-verification bias following a Bayesian approach. Results Thirty-four GPs participated in the study and 133 patients were tested for fCAL between July 2016 and August 2017. Positivity of fCAL was seen in 45/133 patients (34%) and a final IBD diagnosis was made in 10/45 (22%). According to the threshold of 70 μg/g, fCAL achieved a sensitivity of 74.8% (95%CI: 39.10–96.01%), a specificity of 70.4% (95%CI: 61.76–78.16%) and an overall diagnostic accuracy of 70.6% (95%CI: 61.04–78.37%). As for prognostic accuracy, despite positive predictive value being low, 21.9% (95%CI: 11.74–35.18%), the negative predictive value was definitely higher: 96.2% (95%CI: 84.96–99.51%). Conclusions fCAL with a threshold set at 70 μg/g seems to represent a potentially reliable negative test to be used in primary care settings for patients with symptoms suggestive of IBD.

Faecal calprotectin and ultrasonography as non-invasive screening tools for detecting colorectal polyps in children with sporadic rectal bleeding: a prospective study

BackgroundColorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding. Although colonoscopy is widely used in paediatric patients, it requires bowel preparation and general anaesthesia or deep sedation, and in rare cases, it can cause complications. Non-invasive screening techniques able to predict polyps in children with isolated and sporadic rectal bleeding may play a key role in the selection of patients needing colonoscopy.MethodsWe enrolled all children undergoing colonoscopy for isolated and sporadic rectal bleeding to determine the diagnostic accuracy of faecal calprotectin, ultrasonography (US) and digital rectal examination as diagnostic methods for screening colorectal polyps.ResultsA total of 26 of 59 enrolled patients (44.1%) had colonic polyps, one patient had multiple polyps, and 23% of children had polyps proximal to the splenic flexure. The diagnostic accuracy of faecal calprotectin for detecting colorectal polyps was 96.6%, with a sensitivity of 100%. False-positive faecal calprotectin was shown in 2 patients with non-steroidal anti-inflammatory drug-related lesions. The diagnostic accuracy of ultrasound was 77.9%. Polyps not seen with ultrasound tended to be relatively smaller (1.5 vs 2.3, p = 0.001) and located in the rectum. The combined use of FC, US and digital rectal examination obtained a specificity and PPV of 100%.ConclusionsFC combined with US and digital rectal examination is a good and promising non-invasive screening test for detecting colorectal polyps in children with isolated and sporadic rectal bleeding.

Accuracy of Fecal Calprotectin in Detecting Small Bowel Crohn’s Disease: A Meta-Analysis and Systematic Review

Accuracy of Fecal Calprotectin in Detecting Small Bowel Crohn’s Disease: A Meta-Analysis and Systematic Review

What is the accuracy of fecal calprotectin for the diagnosis of inflammatory bowel disease in patients with chronic diarrhea?

What is the accuracy of fecal calprotectin for the diagnosis of inflammatory bowel disease in patients with chronic diarrhea?

P150 Low diagnostic accuracy of faecal calprotectin to predict mucosal inflammation in Crohn’s disease patients with active perianal fistulas

P150 Low diagnostic accuracy of faecal calprotectin to predict mucosal inflammation in Crohn’s disease patients with active perianal fistulas

Accuracy of Faecal Calprotectin and Neutrophil Gelatinase B-associated Lipocalin in Evaluating Subclinical Inflammation in UlceRaTIVE Colitis-the ACERTIVE study.

Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. Macroscopic lesions [i.e. endoscopic Mayo score ≥1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 μg/g for faecal calprotectin and 12 μg/g for neutrophil gelatinase B-associated lipocalin were proposed. Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.

PTU-012 Faecal Calprotectin as Predictor of Small-Bowel Crohn’s Disease in Capsule Endoscopy – A Systematic Review and Meta-Analysis

Introduction Faecal calprotectin (FC) is a well-established marker of gut inflammation. While the correlation of elevated FC levels with colonic inflammation has been confirmed in several studies,1,2 data regarding the correlation of FC with small-bowel inflammation is either scarce or conflicting.3 Capsule endoscopy (CE) is the modality of choice for detection of small-bowel inflammation and/or small-bowel Crohn’s disease (CD).4 Therefore, we aimed to systematically review and meta-analyse the evidence for the diagnostic accuracy of FC as a predictor of small-bowel CD. Methods A comprehensive literature search of the databases PubMed and Embase was performed, using the search string: “capsule endoscopy” + calprotectin. Studies including patients with suspected and/or established CD evaluated by both FC and CE were retrieved. Corresponding authors were contacted for any missing data. The following FC cut-offs were evaluated: >50, 100 and 200 μg/g, as available in each included study. A diagnostic meta-analysis was performed; pooled diagnostic sensitivity (Se), specificity (Sp) and diagnostic odds ratio (DOR) with 95% confidence intervals (95% CI) were obtained for each of the cut-offs. Bias was evaluated using the quality assessment of studies of diagnostic accuracy in systematic reviews (QUADAS) 2 tool. A minimum of 4 studies was required for each analysis. Results A total of 135 studies were identified; seven (3 prospective, 4 retrospective) studies, including 463 patients, entered the final analysis. Overall, the methodological quality of the studies was high, with 6/7 studies showing low risk of bias. For studies including only patients with suspected CD, the diagnostic accuracy of FC for the cut-off of 50 μg/g was as follows: 5 studies, 305 patients; Se 89% (CI 68%;97%), Sp 55% (CI 36%;73%), DOR 10.3 (CI 3.7;28.6) . For all included studies (suspected and established CD), the DOR was significant for all the evaluated FC cut-offs. FC > 50μg/g: 7 studies, 463 patients; Se 83% (CI 73%;90%), Sp 53% (CI 36%;71%), DOR 5.64 (CI 3.2;10.1). FC > 100μg/g: 5 studies, 379 patients; Se 68% (CI 56%;76%), Sp 71% (CI 46%;88%), DOR 5.01 (CI 2.03;12.07). FC > 200μg/g: 4 studies, 309 patients; Se 42% (CI 26%;64%), Sp 94% (CI 64%;99%), DOR 13.64 (CI 2.01;88.6). Sensitivity analysis based on methodological quality did not change those results significantly. Conclusion This meta-analysis confirms that FC, when used as a predictor of small-bowel CD prior to CE, has high diagnostic accuracy. For patients with suspected CD, a FC cut-off level of 50 μg/g provided high sensitivity and DOR, while for the entire patient cohort (suspected and established CD) FC > 200 μg/g provided the best overall DOR. The likelihood of diagnosing small-bowel CD is extremely low in suspected CD patients with FC References 1 D’Haens G, et al. Faecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflamm Bowel Dis 2012;18:2218–2224. 2 Van Rheenen PF, et al. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010;341:c3369. 3 Mao R, et al. Faecal calprotectin in predicting relapse of inflammatory bowel diseases: A meta‐analysis of prospective studies. Inflamm Bowel Dis 2012;18:1894–1899. 4 Annese V, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013;7:982–1018. Disclosure of Interest None Declared

Su1096 Picosulphate/Magnesium Citrate vs Polyethylene Glycol Electolyte Solution for Bowel Preparation: A Meta-Analysis of Randomized Controlled Trials

Background: Endoscopic disease activity in inflammatory bowel disease (IBD) is associated with poor outcomes. Endoscopic evaluation is the gold standard for the assessment of disease activity, but is invasive, expensive and potentially time consuming. Identification of noninvasive biomarkers of disease activity in IBD is a research priority. Methods: The primary objective was to evaluate the diagnostic accuracy of 3 non-invasive biomarkers (fecal calprotectin [FC], stool lactoferrin [SL] and C-reactive protein [CRP]) used for the evaluation of disease activity in IBD. MEDLINE, EMBASE, the Cochrane Library, the ISI Web of Knowledge and conference abstracts were searched from inception to November 2014 for relevant studies. Grey literature databases (e.g. SIGLE) were also searched to identify studies not indexed in traditional databases. All cohort and case-control studies that evaluated the diagnostic accuracy of FC, SL or CRP for assessment of disease activity in symptomatic patients with previously diagnosed IBD (ulcerative colitis and Crohn's disease) were included. True positive, true negative, false positive and false negative rates were extracted for each biomarker and used to construct 2X2 tables for each cutoff. Sensitivity, specificity and area under the curve (AUC) estimates for FC, SL and CRP were calculated for each study based on different cut-offs and pooled together into single estimates for each test. Receiver operator characteristics (ROC) curves were then used to identify the cut-off values for each biomarker that best predicted endoscopic disease activity. Results: Nineteen studies (2456 participants) met our inclusion criteria. Sensitivity, specificity, and AUC values for the 3 biomarkers are summarized in Table 1. The best cut-off values to detect endoscopically active disease in IBD determined by ROC analysis were 50 μg/g, 7.25 μg/mL and 10 mg/dL for FC, SL and CRP, respectively. Conclusions: FC and SL are highly accurate biomarkers that can be used to screen symptomatic IBD patients for endoscopic disease activity prior to colonoscopy. Table 1. Diagnostic Accuracy of Fecal Calprotectin, Stool Lactoferrin, and C-reactive Protein

P238. Accuracy of fecal calprotectin predicting endoscopic activity in Inflammatory Bowel Disease patients

P238. Accuracy of fecal calprotectin predicting endoscopic activity in Inflammatory Bowel Disease patients

P274. Diagnostic accuracy of fecal calprotectin and M2-pyruvate kinase in the prediction of endoscopic activity Crohn's disease

P274. Diagnostic accuracy of fecal calprotectin and M2-pyruvate kinase in the prediction of endoscopic activity Crohn's disease

171 Fecal Calprotectin in Predicting Recurrence After Attack of Colonic Diverticulitis

Backgorund: Colonic diverticulitis shows a high recurrence rate, but the role of fecal markers in predicting recurrence is unknown. The aim of this study was to investigate the role of fecal calprotectin (FC) in predicting recurrence of diverticulitis. Materials and methods: A prospective cohort study was performed on 54 patients suffering from Acute Uncomplicated Diverticulitis (AUD). After remission, patients underwent to clinical follow-up every 2 months. During the follow-up, C-reactive protein (CRP) and FC was analysed at each medical control visit starting 2 weeks after the end of the antibiotic therapy. Recurrence of diverticulitis was defined as return to our observation due to left lower quadrant pain with or without other symptoms (e.g. fever), associated with leucocytosis and/or increased CRP, and confirmed by means of CT. Results: The mean follow-up was 20 months (range 12-24 months). Fortyeight patients were available for the final evaluation, and 6 patients were lost to follow-up. During the follow-up, increased FC was detected in 17 (35.4%) patients. Diverticulitis recurred in 8 (16.7%) patients: 7 (87.5%) patients showed increased FC during the followup, and only 1 (12.5%) patient with recurrent diverticulitis didn't show increased FC. FC sensitivity, specificity, positive predictive value and negative predictive value were 87.5%, 75.0%, 41.2%, and 96.8%, respectively. Only higher FC values (>60 μg/g) correlated with CRP levels (rho=0.351, 95%CI 0.163 to 0.5267; p=0.001). Finally, extension of diverticulosis showed correlation with FC expression (rho=0.632, 95% CI 0.515 to 0.791; p=0.000). Conclusions: Increased FC was found to be predictive of diverticulitis recurrence. Accuracy of fecal calprotectin (FC) test for the diagnosis of recurrent diverticulitis.

173 The Fecal Microbiome in Diverticulitis and Uncomplicated Diverticulosis

Backgorund: Colonic diverticulitis shows a high recurrence rate, but the role of fecal markers in predicting recurrence is unknown. The aim of this study was to investigate the role of fecal calprotectin (FC) in predicting recurrence of diverticulitis. Materials and methods: A prospective cohort study was performed on 54 patients suffering from Acute Uncomplicated Diverticulitis (AUD). After remission, patients underwent to clinical follow-up every 2 months. During the follow-up, C-reactive protein (CRP) and FC was analysed at each medical control visit starting 2 weeks after the end of the antibiotic therapy. Recurrence of diverticulitis was defined as return to our observation due to left lower quadrant pain with or without other symptoms (e.g. fever), associated with leucocytosis and/or increased CRP, and confirmed by means of CT. Results: The mean follow-up was 20 months (range 12-24 months). Fortyeight patients were available for the final evaluation, and 6 patients were lost to follow-up. During the follow-up, increased FC was detected in 17 (35.4%) patients. Diverticulitis recurred in 8 (16.7%) patients: 7 (87.5%) patients showed increased FC during the followup, and only 1 (12.5%) patient with recurrent diverticulitis didn't show increased FC. FC sensitivity, specificity, positive predictive value and negative predictive value were 87.5%, 75.0%, 41.2%, and 96.8%, respectively. Only higher FC values (>60 μg/g) correlated with CRP levels (rho=0.351, 95%CI 0.163 to 0.5267; p=0.001). Finally, extension of diverticulosis showed correlation with FC expression (rho=0.632, 95% CI 0.515 to 0.791; p=0.000). Conclusions: Increased FC was found to be predictive of diverticulitis recurrence. Accuracy of fecal calprotectin (FC) test for the diagnosis of recurrent diverticulitis.

P287 Accuracy of fecal calprotectin in the prediction of endoscopic activity in inflammatory bowel disease patients

Number 1333 (100%) 154 (11.6%) 1007 (75.5%) 135 (10.1%) 37 (2.8%) Male ratio 932 (69.9%) 97 (63.0%) 729 (72.4%) 95 (70.4%) 11 (29.7%) <0.001 Duration of symptoms before diagnosis (mo) 14.9±29.1 5.9±12.6 15.7±29.2 20.1±38.8 12.6±27.7 <0.001 Anti-Tb medication 297 (22.3%) 25 (16.2%) 235 (23.3%) 30 (22.2%) 7 (18.9%) 0.249 Familial history 29 (2.2%) 8 (5.2%) 19 (1.9%) 2 (1.5%) 0 (0%) 0.088 Perianal fistula at diagnosis 326 (24.5%) 40 (26.0%) 272 (27.0%) 11 (8.1%) 3 (8.1%) <0.001 Follow-up duration (mo) 91.1±56.8 98.4±58.7 92.1±57.2 82.9±52.2 62.1±38.3 <0.01

Role of Fecal Calprotectin in Monitoring Response to Therapy in Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBDs) are chronic intestinal disorders characterized by a typically relapsing course. Disease flares occur in a random way and are often unpredictable. In search to provide noninvasive, cheap and rapid methods able to help in diagnosis and monitoring of IBD activity, within the last years, fecal neutrophil-granular proteins, like calprotectin, have been largely studied. Different studies showed a good diagnostic accuracy of fecal calprotectin (FC) in IBDs and a close correlation between levels of this marker and degree of IBD activity.More recently, emerging interest has rising on the role of FC in assessing response to therapy and predicting relapse in IBD. We performed a MEDLINE search for more recent articles published on this topic. Encouraging results show that FC represents a reliable monitoring tool to assess response to treatment, significantly more accurate than serum markers and clinical parameters. Normalization of FC concentrations (FCCs) results as an accurate indicator of endoscopic healing. FC also appears to have a good diagnostic precision in predicting IBD relapse, possibly more in ulcerative colitis than in Crohn’s disease. However, mainly for this last topic, available evidences, although promising, are still heterogeneous and not sufficiently strong. Assessment of usefulness and predictive value of FC according to different medications, frequency of determinations, the establishment of validated cut-off, should be better evaluated in larger and prospective studies.

P314 Accuracy of fecal calprotectin in the assessment of post-operative endoscopic recurrence in patients with Crohn's disease

P314 Accuracy of fecal calprotectin in the assessment of post-operative endoscopic recurrence in patients with Crohn's disease

S1186 The Diagnostic Accuracy of Faecal Calprotectin in Inflammatory Bowel Disease (IBD): A Systematic Review

S1186 The Diagnostic Accuracy of Faecal Calprotectin in Inflammatory Bowel Disease (IBD): A Systematic Review

Discriminant accuracy of fecal calprotectin and hemoquant assays for detection of inflammatory disease in dyspeptic patients: Prospective comparison against endoscopy

Discriminant accuracy of fecal calprotectin and hemoquant assays for detection of inflammatory disease in dyspeptic patients: Prospective comparison against endoscopy