Calprotectin Levels In Children Research Articles

Adherence to the Mediterranean Diet Is Associated with Decreased Fecal Calprotectin Levels in Children with Crohn's Disease in Clinical Remission under Biological Therapy.

Adherence to the Mediterranean diet (MD) was shown to be associated with decreased disease activity in adult patients with Crohn's disease (CD). Nevertheless, data on its association with fecal calprotectin (FC), particularly in children, remain limited. This study aimed to assess the association between adherence to the MD and FC as an indicator of mucosal healing in patients who are predominantly in remission while undergoing biological therapy. This was a cross-sectional study among children with CD. Adherence to MD was evaluated using both the KIDMED questionnaire and a food frequency questionnaire (FFQ). Israeli Mediterranean Diet Adherence Screener (I-MEDAS) score was calculated, and FC samples were obtained. Of 103 eligible patients, 99 were included (mean age 14.3 ± 2.6 years; 38.4% females); 88% were in clinical remission, and 30% presented with elevated FC. The mean KIDMED score was higher among patients who had FC <200 μg/g compared to patients with FC >200 μg/g (5.48 ± 2.58 vs. 4.37 ± 2.47, respectively; p = 0.04). A moderate correlation between the KIDMED score and the I-MEDAS score was observed (r = 0.46; p = 0.001). In a multivariate regression analysis, adherence to MD was associated with decreased calprotectin levels, OR 0.75 [95% CI: 0.6-0.95], p = 0.019. Vegetable consumption was found to be inversely associated with elevated FC (0.9 portion/day [0.3-2.9] in FC >200 μg/g vs. 2.2 portions/day [0.87-3.82] in FC <200 μg/g; p = 0.049). In children with CD who are mostly in clinical remission under biological therapy, high adherence to MD is associated with decreased FC levels. Encouraging vegetable consumption, especially during remission, may benefit these patients.

Serum Calprotectin Levels in Different Subtypes of Juvenile Idiopathic Arthritis (JIA) and Its Correlation with Quantitative CRP and JADAS-27.

To study the serum calprotectin levels in children with juvenile idiopathic arthritis (JIA) and correlate it with C-reactive protein (CRP) and the Juvenile Arthritis Disease Activity Score-27 (JADAS-27). This was a cross-sectional observational study done between November 2017 and March 2019. Fifty treatment-naive children, aged 1 to 18 y with the diagnosis of JIA as per the International League of Associations of Rheumatology (ILAR) criteria were enrolled. Assessment of disease activity was done according to the Juvenile Arthritis Disease Activity Score (JADAS-27). Determination of serum calprotectin and CRP levels was done by immunoassay. The correlation between calprotectin levels with CRP and JADAS-27 was calculated. Of the 50 patients with JIA included in the study, there were 18 female and 32 male children. The median age of presentation to the hospital was 9 y (IQR 5.82-13). The median JADAS-27 was 14 (IQR 6, 20.25). The median serum calprotectin level was 45,375 ng/mL (IQR 30,725, 52,270; range 8,560-63,160 ng/mL). The median CRP was 35.4mg/L (IQR 3.48, 80.3; range 0.02 and 107.4mg/L). The levels of calprotectin in different JIA subtypes were not statistically different using Kruskal-Wallis test. The study also demonstrated a positive correlation between serum calprotectin with CRP and the JADAS-27 (r = 0.418). The calprotectin levels in JIA were significantly higher than those reported in the literature irrespective of the subtype. Serum calprotectin positively correlated with CRP and JADAS-27 in children with JIA.

Association between body mass index and fecal calprotectin levels in children and adolescents with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common pediatric functional gastrointestinal disorder. It is characterized by recurrent abdominal pain and changes in bowel habits and is more prevalent in obese patients. We investigated the association between obesity and IBS in pediatric patients through fecal calprotectin testing.Patients under 18 years of age with IBS who underwent fecal calprotectin testing from January 2015 through April 2020 were retrospectively investigated. The patients were divided into groups based on body mass index (BMI): group I (BMI < 85th percentile) and group II (BMI ≥ 85th percentile). Group II was divided into group IIa, overweight (85th percentile ≤ BMI < 95th percentile), and group IIb, obese (BMI ≥ 95th percentile).Among 277 included patients, 202 (72.9%) were in group I, and 75 (27.1%) were in group II (mean calprotectin levels, 75.60 ± 103.48 vs 45.89 ± 66.57 µg/g, respectively; P = .006). There were significant differences in mean calprotectin levels between groups I and IIa (75.60 ± 103.48 vs 45.45 ± 63.38 µg/g, respectively; P = .028) and groups I and IIb (75.60 ± 103.48 vs 46.22 ± 69.59 µg/g, respectively; P = .025). There was a significant difference in mean calprotectin levels between groups I and II (85.69 ± 142.13 vs 32.04 ± 28.17 µg/g, respectively; P = .029) among patients between 6 and 12 years of age but not among adolescents aged between 12 and 18 years (P = .139). Fecal calprotectin was lower when moderate-to-severe fatty livers were observed by ultrasound compared with normal livers (68.52 ± 97.22 vs 18.53 ± 18.56 µg/g, respectively; P = .017).Fecal calprotectin levels were higher in normal-weight pediatric IBS patients than in their obese counterparts, and this difference was more prominent in younger patients. In young children, IBS symptoms are thought to be influenced more by factors other than intestinal inflammation.

P326 The effect of compliance during exclusive enteral nutrition on faecal calprotectin levels in children with Crohn’s disease

Abstract Background It is yet unclear whether suboptimal response to exclusive enteral nutrition (EEN), in some children with Crohn’s disease (CD), is explained by poor compliance. All proprietary feeds used for EEN are gluten-free; hence patients’ compliance to EEN could be determined by detecting gluten immunogenic peptide (GIP), a biomarker of gluten intake, in faeces. Methods The concentration of GIP was measured in the faeces of, 45 children (3–17 years) with CD prior to and during (33 &amp;, 54 days) treatment with EEN. Associations with GIP and faecal calprotectin (FCAL) levels were explored at, 33 and, 54 days of EEN. Results GIP was present in, 37 of the, 40 (93%) patients who provided stool samples prior to starting EEN, indicating typical gluten consumption in CD patients. In patients with undetectable GIP at both, 33 and, 54 days of EEN, FCAL significantly decreased from baseline (mean decrease, 33 days: -743mg/kg, 54 days: -1043mg/kg, p&amp;lt;0.001), but not in patients who had detectable GIP. At EEN completion, patients with undetectable GIP had a lower FCAL by, 763mg/kg than patients with a positive GIP result (p=0.041) and demonstrated a greater decline from baseline FCAL (-69% vs +5.%, p=0.021). Conclusion Poor response to EEN might be explained at least in part by diminished compliance and dietary transgressions. Faecal GIP might be useful as a proxy biomarker of EEN compliance.

Guidance on the interpretation of faecal calprotectin levels in children.

BackgroundFaecal calprotectin (FCP) is a powerful tool to predict inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. In the paediatric patient population, the reference value of < 50 μg/g and the influence of age on FCP levels result in a high number of redundant investigations and specialist referrals. We assessed paediatric FCP levels, their diagnostic value and corresponding referral pathways from primary and secondary care.MethodsWe analysed two cohorts from a precisely defined catchment area: one consisted of all FCPs measured in this area (n = 2788). The second cohort—a subset of the first cohort—consisted of FCP values and corresponding clinical data from children who were referred for possible IBD to our department (n = 373).ResultsIn the first cohort, 47% of FCP levels were > 50 μg/g, 15% were ≥ 250 μg/g. Children < 1y had significantly (p < 0.001) higher FCP than older children. In the second cohort, 6.7% of children with an FCP of < 250 μg/g (or 8.6% with an FCP of < 600 μg/g) had IBD–all featured symptoms suggestive of IBD (e.g. bloody diarrhoea, nocturnal abdominal pain, weight loss) or abnormal blood tests. 76% of patients in whom raised FCP (> 50 μg/g) was the sole reason for being referred for suspected IBD did not have IBD.ConclusionChildren with an FCP < 600 μg/g and without matching symptoms suggestive of IBD are unlikely to have IBD. A higher FCP reference value may provide cost-effective improvement that could avoid redundant investigations and specialist referrals. A guideline for specialist referrals is proposed.

Clinical Spectrum in a Cohort of Patients With High Fecal Calprotectin Levels.

Introduction: Distinguishing between inflammatory bowel disease (IBD) and functional gastrointestinal disorders is a diagnostic challenge. The need for non-invasive biomarker as a diagnostic tool in the assessment of gastrointestinal symptoms is required. The objectives of current study were to determine the spectrum of clinical features in patients tested for fecal calprotectin presenting with high levels and to compare calprotectin levels among already diagnosed patients known to have IBD as per biopsy findings and documented on patients' file with newly presenting patients who were being investigated and did not have a diagnosis.Methods: This retrospective cross-sectional study was conducted in the Department of Pathology and Laboratory Medicine and Department of Medicine, Aga Khan University, Karachi, Pakistan from January 2017 to December 2019. Subjects tested for fecal calprotectin who had elevated fecal calprotectin levels (n = 150) were included in the current study. Each patient deposited a random stool sample in an airtight container for calprotectin analysis. Biochemical analysis of calprotectin was performed by enzyme-linked immunosorbent assay using epitope calprotectin test kit (Epitope Diagnostics, Italy) on ETI-Max 3000 immunoassay analyzer (DiaSorin, Italy). A structured history form was used for data collection. Results: One hundred and fifty patients were available for inclusion in the final analysis. Majority of the patients (n = 117, 78%) were adults (>18 years of age), and 52.7% (n = 79) were females. Median fecal calprotectin (IQR) was 317.3 μg/g (549.10 - 239.2 μg/g) in children (n = 33) and 305 μg/g (609.9 - 201.6 μg/g) in adults; the difference was statistically non-significant (p value > 0.05). On categorization according to disease, fecal calprotectin levels were significantly elevated (p value = 0.033) in IBD patients compared to normal subjects, 644 μg/g (644 - 587.8 μg/g) vs 308.5 μg/g (505.4 - 233.8 μg/g), respectively. Diarrhea (n = 13, 38.4%), abdominal cramps (n = 12, 36.4%), and weight loss (n = 11, 33.3%) were the most common complaints noted in children with high fecal calprotectin levels, whereas in adults, abdominal cramps (n = 60, 51.3%), diarrhea (n = 59, 50.4%), and weight loss (n = 46, 39.3%) were the common complaints. The median fecal calprotectin levels in children already known to have IBD (n = 3) were higher than the levels noted in children with no diagnosis (n = 30); p value > 0.05. Similarly, median fecal calprotectin levels in adults with IBD (n = 28) were higher than the levels noted in patients with no specific diagnosis (n = 91), 400.7 μg/g (656.6 - 244.3 μg/g) vs 302.7 μg/g (564.6 - 206 μg/g); p value > 0.05.Conclusion: Current study affirms that the fecal calprotectin test can be used in identifying IBD patients in all age groups.

Evaluation of the Relationship between Mucosal Diseases and Faecal Calprotectin Levels in Children who Underwent Upper Gastrointestinal System Endoscopy

Evaluation of the Relationship between Mucosal Diseases and Faecal Calprotectin Levels in Children who Underwent Upper Gastrointestinal System Endoscopy

Age-dependent variation of fecal calprotectin in cystic fibrosis and healthy children

BackgroundFecal calprotectin may be used as a non-invasive method to assess the effect of novel therapies on the gut in cystic fibrosis (CF). MethodStools from CF patients and healthy controls (HC) (0–10years old) were prospectively collected for evaluation of temporal trends. Results130 CF samples (64 subjects) and 114 HC samples (101 subjects) were collected. Overall, fecal calprotectin levels were different in CF patients and HC from 0 to 10years (P=0.0002). Fecal calprotectin in CF was significantly lower than HC from 0 to 1years (P=0.03) and demonstrated an upward trajectory until 4years. From >4 to 10years calprotectin was consistently higher in CF patients compared with HC (P=0.007). ConclusionsFecal calprotectin levels in children with CF and HC were age-dependent and had distinct trajectories. Careful interpretation of calprotectin is required if used in drug trials for CF, particularly in children less than 4years old.

Faecal calprotectin levels in children with Henoch-Schönlein purpura: is this a new marker for gastrointestinal involvement?

We aimed to investigate the significance of faecal calprotectin (FC) levels in children diagnosed with Henoch-Schönlein purpura (HSP) and examine its relationships with gastrointestinal system (GIS), renal involvement and with clinical findings. In total, 66 children diagnosed with HSP for the first time and a control group of 25 healthy children were included. The cases were divided into mild and severe groups on the basis of GIS findings. FC was measured twice in all patients with HSP: within 3 days of onset of disease (FC1) and on day 15 (FC2). These results were compared with those of the control group. Faecal occult blood, gastric wall thickness and duodenal wall thickness were measured at the same time as FC1 in all patients, and the presence of renal involvement was recorded. Of the 66 patients, 37 (56%) were females (mean age, 7.5±2.9 years; range, 2.5-14.5 years) and were diagnosed with HSP. Renal involvement was detected in 19 (28%) cases and GIS involvement was found in 28 (43%) cases. GIS involvement was mild in 16 (53%) cases and severe in 12 (43%). A significant difference was detected in FC1 levels between the groups with and without GIS involvement (P=0.01). A marked difference was observed in FC1 levels between the groups with and without renal involvement (P=0.017). FC may be a reliable marker for HSP, particularly for identifying GIS and renal involvement as well as disease severity.

Correlation between gut pathogens and fecal calprotectin levels in young children with acute diarrhea

Background In cases of acute diarrhea, it is difficult to distinguishbetween bact erial and non-bacterial causes . Increased fecalcalprotectin (f-CP) level is a marker of neutrophil migration in theintestinal lumen and is associated with intes tinal inflammation.Previous studies reported an increase in f-CP levels in childrenwith acute diarrhea, which is caused by bacteria, but only fewhave studied the relationship between intestinal pathogens withf-CP levels in acute diarrhea.Objective To assess for a correlation between gut pathogens andfecal calprotectin levels in children with acute diarrhea.Methods We conducted a cross-sectional study between Julyto November 2012 on children aged 1-5 ye ars with acutediarrhea, and underwent routine blood tests, stool microscopy,f-CP tests, and stool cultures. We used a simple linear regressionand correlation analysis with a significance level of P&lt; 0.05.Results Forty-two children enrolled in this study. The mean age ofsubjects was 2.27 (SD 134) years. Theirmeanf-CP level was 93.88(SD 14.68) μg/g. On microscopic stool examination, 26 patients( 61.9%) had positive leukocytes, 1 had Ancy lo stoma duodenale, 1had Ascaris lumbricoides, and 2 had Blastocystis hominis. Positivestool cultures were found in 14 children (33.3%) with acutediarrhea. There was a significant positive correlation between gutpathogens and f-CP levels (r=0.605; P&lt; 0.0001).Conclusion In young children with acute diarrhea, the averagef-CP levels are higher in those with positive intestinal pathogens.

Rapid Test for Fecal Calprotectin Levels in Children With Crohn Disease

Assessment of fecal calprotectin, a surrogate marker of mucosal inflammation, is a promising means to monitor therapeutic response in pediatric inflammatory bowel disease, especially if the result is readily available. We tested the performance of a novel calprotectin rapid test, Quantum Blue, versus the conventional enzyme-linked immunosorbent assay in 134 stool samples from 56 pediatric patients with Crohn disease. The intraclass correlation coefficient analysis reflected good agreement (intraclass correlation coefficient 0.97 [95% confidence interval 0.95-0.98]) but agreement was better in lower values, where dilutions were not required. Using a cutoff of 100 μg/g for normal values, the percentage agreement between the 2 tests was 87%. The optimal cutoff values to guide clinical decisions in the therapy of inflammatory bowel disease have yet to be determined.

Fecal Calprotectin in Children with the Enthesitis-related Arthritis Subtype of Juvenile Idiopathic Arthritis

To the Editor: Subclinical gut inflammation is present in two-thirds of adult and pediatric patients with spondyloarthritis (SpA)1,2 and predicts a chronic course of arthritis2,3. Thus, there may be value in evaluating the gut in patients with SpA. However, commonly used tests, such as colonoscopy, barium studies, and computed tomography, are limited by expense, invasiveness, or radiation exposure4, prompting a need for noninvasive surrogate markers. Serologic markers revealed a large number of false-positive tests5. Fecal calprotectin is a sensitive and specific marker for the presence of inflammatory bowel disease or other intestinal illnesses6. This test has not heretofore been used to assess for subclinical gut inflammation in patients with arthritis. In this study, we measured fecal calprotectin levels in children with enthesitis-related arthritis (ERA), comparing them to children with non-SpA subtypes of juvenile idiopathic arthritis (JIA), as well as children with unrelated connective tissue diseases (CTD) and noninflammatory control subjects. We enrolled 4 groups of children: (1) 9 with the ERA subtype of JIA; (2) 17 with other subtypes of JIA [persistent oligoarticular, n = 6; extended oligoarticular, n = 1; rheumatoid factor-negative (RF–) polyarticular, n = 8; RF+ polyarticular, n = 2]; (3) 9 with unrelated CTD (dermatomyositis, n = 3; localized scleroderma, n = … Address correspondence to Dr. Punaro; E-mail: Marilynn.Punaro{at}TSRH.org.