Fecal Calprotectin In Patients Research Articles

Fecal Calprotectin in Patients with Crohn's Disease: A Study Based on the History of Bowel Resection and Location of Disease.

Fecal calprotectin (FC) is commonly used to assess Crohn's disease (CD) activity. However, standardized cut-off values accounting for bowel resection history and disease location are lacking. In this study, we analyzed data from patients with CD who underwent magnetic resonance enterography, ileocolonoscopy, and FC measurements from January 2017 to December 2018. In 267 cases from 254 patients, the FC levels in the 'operated' patients were higher when the disease was active compared with those who were in the remission group (178 vs. 54.7 μg/g; p < 0.001), and similar findings were obtained for the 'non-operated' patients (449.5 vs. 40.95 μg/g; p < 0.001). The FC levels differed significantly according to the location of inflammation, with lower levels in the small bowel compared to those in the colon. The FC cut-off levels of 70.8 μg/g and 142.0 μg/g were considered optimal for predicting active disease for operated and non-operated patients, respectively. The corresponding FC cut-off levels of 70.8 μg/g and 65.0 μg/g were observed for patients with disease only in the small bowel. In conclusion, different FC cut-off values would be applicable to patients with CD based on their bowel resection history and disease location. Tight control with a lower FC target may benefit those with a history of bowel resection or small-bowel-only disease.

İnflamatuvar Bağırsak Hastalığında Tanı Anındaki Fekal Kalprotektin Komplikasyon Varlığını Gösterebilir

Aim: We aimed to investigate the relationship between the presence of complications at the time of diagnosis or during follow-up and fecal calprotectin in patients with inflammatory bowel disease. Materials and Methods: Fecal calprotectin level was studied by the chromatographic lateral flow immunoassay method. Results: A total of 76 patients, 26 (34%) with Crohn's disease and 50 (66%) with ulcerative colitis, were included in the study. At the time of diagnosis and during follow-up, complications were observed in 17 (22%) and 20 (26%) patients, respectively. At the time of diagnosis, fecal calprotectin level was low (&amp;lt;50 mg/kg) in 26 (34%) patients, borderline (50-100 mg/kg) in 16 (21%) patients, and high (&amp;gt;100 mg/kg) in 34 (45%) patients. Hemoglobin and albumin levels were lower (p=0.013, p=0.012, respectively), and platelet count, eryrocyte sedimentation rate, and C-reactive protein levels were higher (p&amp;lt;0.001, p=0.004, p&amp;lt;0.001, respectively) in patients with high fecal calprotectin level than patients with low fecal calprotectin level. At the time of diagnosis and during follow-up, complications were higher in patients with high fecal calprotectin level than patients with low and borderline fecal calprotectin levels (p=0.001). The risk of developing complications was found to be 26 times higher at the time of diagnosis in patients with fecal calprotectin level &amp;gt;100 µg/g than patients with fecal calprotectin level below this value and 8 times higher during follow-up (p=0.006, p=0.015, respectively). Conclusion: The use of fecal calprotectin level together with tests showing acute inflammation in inflammatory bowel disease may predict the development of complications.

P1206 Mechanistic implications of the Mediterranean diet in patients with newly diagnosed Crohn’s disease- multi-omic analysis of a prospective cohort

Abstract Background The Mediterranean diet (MED) is hypothesized to play a protective role in Crohn’s disease (CD) etiology, yet the underlying mechanisms remain unclear. Here we explored the association between adherence to MED, CD course, clinical and inflammatory markers, and microbial and metabolite composition in patients with newly diagnosed CD. Methods Patients with newly diagnosed CD were recruited and prospectively assessed. Food frequency questionnaires (FFQ) were collected each visit and assessed for adherence to MED, using a predefined IBDMED score, alongside validated MED adherence screeners. The Crohn’s disease activity index (CDAI) was used to evaluate clinical activity and serum and fecal samples collected for fecal calprotectin, C-reactive protein (CRP), and microbial composition using 16S rRNA sequencing. Baseline serum and fecal metabolomics were analyzed using a targeted quantitative metabolomics approach. Patients were classified as having a complicated course if during follow-up, they were steroid dependent, switched ≥2 biologics, hospitalized or underwent CD-related surgery. Results We recruited and prospectively observed 271 consecutive patients with newly diagnosed CD (52% males, average age- 31±12 years, inflammatory phenotype, B1- 75%) and collected 636 FFQs (range 1-5 FFQ per patient). Adherence to MED was associated with a non-complicated course and was inversely correlated with CDAI, fecal calprotectin, CRP and microbial dysbiosis index (all p&amp;lt;0.05). Increasing adherence to MED over time was associated with decreasing CDAI and fecal calprotectin in patients with complicated and non-complicated courses (p&amp;lt;0.05). Diet microbial interactions revealed two microbial clusters, showing that adherence to MED and intake of its recommended foods positively correlated with commensals and short-chain fatty acid producers including Faecalibacterium. Conversely, adherence to MED inversely correlated with a cluster of members of the Proteobacteria and included Ruminococcus gnavus. Diet metabolomics interactions revealed two clusters showing that adherence to MED positively correlated with multiple serum and fecal organic compounds, vitamin derivatives, plant metabolites, amino acids and tryptophan metabolites and inversely associated with fecal triglycerides, ceramides and cholic acid, the major primary bile acid (FDR&amp;lt;0.1). Conclusion Adherence to MED is associated with lower levels of primary bile acids and microbial dysbiosis and with a beneficial microbial and metabolite composition in patients with newly diagnosed CD. This may drive the inverse association of MED with clinical activity, inflammatory markers and complicated course. Microbial and metabolite-targeted dietary approaches like MED, should play a role in CD management.

Fecal calprotectin in patients with liver cirrhosis.

Sepsis is the most challenging complication in patients with liver cirrhosis. It destabilizes patients leading to worsening of liver dysfunction and increased mortality. Intestinal bacterial dysbiosis, release of endotoxins, increased gut permeability and associated immune dysregulation have been described in cirrhotic patients with septic complications. Calprotectin is a major cytosolic protein secreted by the inflammatory cells and has been widely studied in patients with inflammatory bowel disease. We aimed at evaluating the role of fecal calprotectin (FCAL) in patients with liver cirrhosis. A prospective, observational study on the utility of FCAL test was conducted in patients with liver cirrhosis. Fifteen milligrams of fecal specimen was collected and analyzed within 48hours of hospitalization from patients with end-stage liver disease (ESLD), acute-on-chronic liver failure (ACLF) and at the time of outpatient visit for stable cirrhotics. Five healthy volunteers underwent FCAL test as control population. The mean FCAL (µg/g) level in healthy control (n = 5), stable cirrhotics (n = 10), ESLD (n = 10) and ACLF (n = 10) patients was 109.2 (95% CI: - 53.39 to 271.79), 143.3 (95% CI: 50.5-236.45), 176.9 (95% CI: 122.93-230.87) and 543.5 (95% CI: 207.09-879.91) (p = 0.005), respectively. Sepsis was identified in 13 (43.3%) patients. Area under the receiver-operating characteristics curve (AUROC) of FCAL was 0.80 (p = 0.005) and FCAL ≥ 200µg/g (OR = 10.8, p = 0.006) was associated with sepsis. Nine (25.7%) patients expired. FCAL level was significantly higher in dead patients compared to survivors (mean, 493.67 (95% CI: 142.20-845.14) vs. 199.71 (95% CI: 99.84-299.59) μg/g,p = 0.005. FCAL levels are increased in patients with chronic liver disease, with highest level in ACLF. An FCAL level of ≥ 200µg/g was associated with sepsis and mortality in cirrhotic patients. Larger studies are required to identify the role of FCAL in these patients. Early identification and initiation of anti-microbials may mitigate sepsis and reduce mortality.

P694 Long-term monitoring of post-surgical recurrence in Crohn’s disease using a strategy based on the periodic determination of fecal calprotectin in patients without early postoperative recurrence

Abstract Background Current guidelines recommend to perform an ileocolonoscopy 6-12 months after surgery in patients with Crohn’s disease (CD) and ileo-cecal resection with ileocolic anastomosis to assess the occurrence of endoscopic post-operative recurrence (PORe) and escalate therapy if necessary. However, it is not established whether and/or when endoscopic monitoring is advised in patients who do not present early PORe Objective To evaluate the usefulness of a strategy based on the periodic determination of faecal calprotectin (FC) to decide whether to carry out a new endoscopic control in patients without PORe (iR&amp;lt;2) in the last endoscopic assessment performed Methods Pilot, prospective, multicentre and open study. Inclusion criteria: 1) CD with intestinal resection and ileo-colic anastomosis; 2) last ileocolonoscopy after surgery with a Rutgeerts score i0 or i1; 3) No suspicion of clinical POR. Patients with an ostomy or chronic use of NSAIDs or omeprazole were excluded. Centralized FC determinations were performed every 4 months for 2 years and an ileocolonoscopy at the end of follow-up was performed. In the case of FC&amp;gt;250μg/g in 2 consecutive determinations, ileocolonoscopy was advanced and the patient was withdrawn from the study. The main variable of interest was the rate of advanced PORe (as defined by Rutgeerts score &amp;gt;i2) at the final ileocolonoscopy. Results 55 patients were included, 13% perianal disease, 24% smokers and 27% surgery prior to the index surgery. 47% followed prevention with thiopurines and 14% with anti-TNF. During follow-up, 7 patients had FC&amp;gt;250μg/g in two consecutive determinations; advanced PORe was identified in 5 of these patients, PORe i2 in one and intestinal adenocarcinoma in another one. Among the patients who completed the 2-year follow-up, none had advanced PORe at the final ileocolonoscopy although intermediate PORe (i2) was found in 12. The rate of advanced PORe was 71% in those who finished the study before 2 years and 0% in those who were not advanced to endoscopy. The AUC for FC to detect advanced PORe was 0.98 (p=0.002). The cut-off point of FC&amp;gt;250μg/g obtained a sensitivity of 100% and specificity of 60% to detect advanced PORe. Conclusion The serial determination of FC is a suitable long-term monitoring tool to decide whether to perform ileocolonoscopy in patients without early PORe.

Перспективный биомаркер интестинального воспаления у больных хронической болезнью почек

The aim of the study was to investigate the content of fecal calprotectin in patients at different stages of chronic kidney disease (CKD). The study included 3 groups of patients: the 1st group included 80 patients with terminal renal failure (TRF) treated by hemodialysis; the 2nd group included 30 patients with S3a-5 CKD (glomerular filtration rate (GFR) 60 ml/min/1.73 m2); the 3rd group included 20 patients with CKD S1-2 (GFR 60 ml/min/1.73 m2 ), comparable by the main clinical and demographic characteristics. The level of fecal calprotectin significantly increased along with the severity of renal failure and reached maximum values in patients on dialysis. In addition, in the groups of patients with moderately severe and severe CKD the concentration of fecal calprotectin was significantly correlated with C-reactive protein (CRP) and the activity of gastrointestinal symptoms (GIS) assessed by the Gastrointestinal Symptoms Questionnaire (GSQ).

Association between morphological manifestations of inflammatory bowel disease and biochemical markers of inflammation

Aim. To determine morphological and morphometric changes in the structure of the mucous membrane of the large intestine and their relationship with the content of short-chain volatile fatty acids and fecal calprotectin in patients with inflammatory bowel disease. Materials and methods. We examined 68 patients with inflammatory bowel disease, including 30 women and 38 men aged 20–66 years, 55 patients were with ulcerative colitis and 13 patients – with Crohn’s disease. Histological examination focused on changes in the mucous membrane of the large intestine. Determination of short-chain volatile fatty acids in feces was performed using gas chromatography. Calprotectin content was measured in fecal samples by enzyme-linked immunosorbent assay. Results. Significant correlations were found between epithelial disruption and changes in crypt architecture, infiltration density, and histological activity. The higher degree of inflammation in patients with severe course was combined with a lower level of tissue nonspecific protection, which was detected by the number of goblet cells, eosinophilic and neutrophilic leukocytes. There was a decrease in the fecal concentration of butyric acid in patients with nonspecific ulcerative colitis and Crohn’s disease compared with controls, but a more significant decrease was observed in patients with severe nonspecific ulcerative colitis. The data have confirmed the association between inflammatory bowel disease and the content of short-chain volatile fatty acids, fecal calprotectin in coprofiltrate, which was evidenced by the presence of correlations between low content of short-chain volatile fatty acids and eosinophilic infiltration (r = -0.412; fecal calprotectin levels and disease severity (r = 0.589; P = 0.001), atrophy (r = 0.458; Р &lt; 0.05), infiltration density (r = 0.434; Р &lt; 0.05). Conclusions. All patients with inflammatory bowel disease are characterized by a specific histological picture, which reflected the different degrees of inflammation. Morphometric parameters more accurately show significant atrophic changes in the mucous membrane of the large intestine. The data have confirmed the association between inflammatory bowel disease and the content of short-chain volatile fatty acids and calprotectin in coprofiltrate.

COVID-19 Pneumonia and Gut Inflammation: The Role of a Mix of Three Probiotic Strains in Reducing Inflammatory Markers and Need for Oxygen Support.

Background: COVID-19 disease, which typically presents with respiratory symptoms, can trigger intestinal inflammation through SARS-CoV-2 replication in the gastrointestinal tract. Supplementation with probiotics may have beneficial effects on gut inflammation due to their analgesic and anti-inflammatory properties. The primary objective of our study was to evaluate the efficacy of a mix of three probiotic strains (Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201; Lactibiane Iki®) in the reduction in fecal calprotectin in patients with COVID-19 pneumonia, compared to a control group. The secondary aim was to evaluate the reduction in oxygen support and length of hospital stay in patients taking the probiotic mix. Patients and Methods: We conducted a prospective randomized controlled trial at Fondazione Policlinico Gemelli, Rome. We enrolled patients with COVID-19 interstitial pneumonia. One group received the probiotic mix twice a day for 10 days in addition to the standard COVID-19 therapy, and a second group received standard COVID-19 therapy without probiotics. We administered oxygen support (through Ventimask or Optiflow®) on days (D) 1, 3, 5, 7 and 10, and the level of fecal calprotectin between D3–D5 and D7–D10. Results: A total of 80 patients (44 M/36 F; mean age: 59.8 ± 17.3) were enrolled with a mean value of calprotectin at enrollment of 140 mg/dl. At D7–10, the probiotic group showed a 35% decrease in fecal calprotectin compared to 16% in the control group, a decrease in C-reactive protein (CRP) of 72.7% compared to 62%, and a slight but not significant decrease in oxygen support compared to the control group. Conclusion: Supplementation with a mix of probiotics for 10 days in patients with COVID-19 interstitial pneumonia significantly reduces inflammatory markers.

The clinical utility of faecal calprotectin in patients with differentiated and undifferentiated spondyloarthritis: Relevance and clinical implications

ObjectivesThere is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. Material and methodsA total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. ResultsThe differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). ConclusionsElevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.

The Clinical Utility of Faecal Calprotectin in Patients with Differentiated and Undifferentiated Spondyloarthritis: Relevance and Clinical Implications.

There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.

Association of polymorphisms in promoter region of TNF-α-238 and -308 with clinical outcomes in patients with immune-mediated inflammatory diseases on anti-TNF therapy.

The hypothesis of the study was that polymorphisms in promoter regions -238 and -308 of TNF-α could be associated with different clinical outcomes in inflammatory bowel diseases (IBD) and immune-mediated rheumatic diseases (IMRD). The aim was to examine the possible association of both polymorphisms with concentration of C-reactive protein (CRP) and fecal calprotectin (fCAL), onset of the remission and development of the ADA in patients on therapy with anti-TNF inhibitors. The prospective study was done in patients with IBD and IMRD on infliximab (IFX) or adalimumab (ADM). Patients were genotyped for TNF-α-238 and -308 polymorphisms. The concentration of CRP, fCAL, IFX or ADM and antibodies to drugs were measured according to manufacturer's instructions and followed-up for 6 or 12months. Out of all patients (N = 112), number of patients in remission did not differ according to genotypes (for IBD patients P = 0.509 vs 0.223; for IMRD patients P = 0.541 vs 0.132 for TNF-α-238 and -308, respectively). Initial CRP concentration was higher in IBD patients with TNF-α -308 GG than GA/AA genotypes in patients who failed to achieve remission [11.8 (4.4-39.6) vs 3.1 (1.5-6.5), P = 0.033]. In IBD patients with remission, fCAL concentration after at least 6months of therapy was higher in TNF-α-308 GG than in GA genotype [52 (25-552) vs 20 (20-20) µg/g, P = 0.041]. Our results showed the association of TNF-α-308 GG genotype with a higher concentration of CRP and fecal calprotectin in patients with inflammatory bowel diseases on IFX or ADM therapy. Clinical remission and development of antibodies to anti-TNF drugs were not associated with TNF-α-238 and -308 polymorphisms.

Calprotectin in viral systemic infections-COVID-19 versus hepatitis C virus.

This study aims to evaluate differences in serum and fecal calprotectin in patients with HCV chronic hepatitis and COVID-19 infection and compare them to a control group. This observational study was performed between April 2020 and October 2020 in a single Internal Medicine center. We determined serum and fecal calprotectin, as well as levels of transaminases, C-reactive protein, ferritin, in 25 patients with COVID-19 infection, 30 patients with active HCV chronic infection and 38 patients with cured HCV infection. Serum levels of ALT, AST, C-reactive protein and ferritin were significantly higher in patients with COVID-19 infection (mean values of 127 IU/mL, 135 IU/mL, 123 mg/L and 1034 ng/mL, respectively) than in patients with active HCV infection (mean values of 68 IU/mL, 51 IU/mL, 17 mg/L and 528 ng/mL, respectively) or in patients with cured HCV infection (37 IU/mL, 29 IU/mL, 3.4 mg/L and 274 ng/mL, respectively). Also, serum and fecal calprotectin had increased concentrations in patients with COVID-19 (7.3 µg/mL and 394 µg/mg) versus patients with active hepatitis (2.4 µg/mL and 217 µg/mg) and patients with cured hepatitis (1.2 µg/mL and 38 µg/mg). Values were significantly higher in patients with digestive symptoms related to COVID-19. Serum and fecal calprotectin can be used as inflammatory markers in patients with active viral infections. In COVID-19, calprotectin concentrations can be correlated to the severity of disease, particularly in patients with digestive symptoms.

P154 Faecal calprotectin and patient reported disease control of IBD: results from the baseline dataset of the PREdiCCt study

Abstract Background There is an established disconnect between intestinal inflammation and symptoms in patients with IBD. Faecal calprotectin (FCAL) is an excellent surrogate for mucosal healing and we have good data to support treat to target approaches based on FCAL. However, there is relatively little data analysing how well FCAL correlates with a fuller breakdown of a patient’s symptoms. We were interested to explore the impact of ongoing intestinal inflammation as measured by FCAL in patients reported to be in clinical remission. Methods The PREdiCCt study (https://www.predicct.co.uk) is the largest prospective study of the causes of IBD flare. 2629 patients in clinical remission were recruited from 48 UK sites and followed for 2 years. 1946 (74%) patients completed the baseline questionnaires. We present here the results of the baseline questionnaire analysis of IBD symptoms (IBD Control questionnaire). Eight of the question items generate a summary score (IBDControl-8) ranging from 0 (worst control) to 16 (best control). This questionnaire also includes a visual analogue scale (VAS) for disease control ranging from 0 (worst control) to 100 (best control). These data were matched to a contemporaneous FCAL measurements, taken at study entry. Results IBD Control-8 results are available in 1,919 patients [male=840, CD=985 UC/IBDU=934, age 45.8±15.5 (mean±SD in years)]). Median FCAL values were 46 mcg/g (IQR 20–150) for the overall cohort, 50 mcg/g (IQR 20–156) for CD and 39 mcg/g (IQR 20–143) for UC. UC patients reported better disease control compared to CD patients (p&amp;lt;0.001, for both IBDControl-8 and VAS). CD patients with previous surgery (p=0.031 for IBDControl-8) and perianal disease (p=0.015 and p=0.035, for IBDControl-8 and VAS respectively) reported worse disease control than the rest of the CD patients. Better disease control was reported in males versus female patients (p&amp;lt;0.001 and p=0.003 for IBDControl-8 and VAS respectively). There was a negative correlation between baseline FCAL values and (p&amp;lt;0.001). Patients who reported waking up at night due to their disease had higher FCAL values at baseline [median 60 mcg/g (IQR 20–162) vs 43 mcg/g (IQR 20–144), p=0.013] with the correlation being more prominent in UC (p=0.002). Patients who reported the need to change their treatment had higher FCAL values at baseline [85 mcg/g (IQR 24–336) vs 43 mcg/g (IQR 20–139), mcg/g, median (IQR), p=0.032]. Conclusion This is the first detailed symptom examination of clinical versus deep remission. We show how residual gut inflammation in patients in clinical remission affects meaningful patient reported outcomes measures including waking at night. UC and male patients reported better disease control compared to CD and female patients.

Correlation between Vitamin D, Some Circulating Micro RNA with CRP and Faecal Calprotectin in Patients with Crohn’s Disease

Correlation between Vitamin D, Some Circulating Micro RNA with CRP and Faecal Calprotectin in Patients with Crohn’s Disease

Elevated Faecal Calprotectin in Patients with a Normal Colonoscopy: Does It Matter in Clinical Practice? A Retrospective Observational Study

Introduction: Faecal calprotectin (FC) is commonly used as a diagnostic tool for patients with gastrointestinal (GI) symptoms. However, there is uncertainty in daily clinical practice how to interpret an elevated FC in patients with a normal colonoscopy. We investigated if patients with a normal colonoscopy but with an elevated FC more often were diagnosed with a GI disease in a 3-year follow-up period. Methods: Patients referred for colonoscopy (n = 1,263) to the Umeå University Hospital endoscopy unit between 2007 and 2013 performed a FC test (CALPRO^®) on the day before bowel preparation. A medical chart review was performed on all patients who had normal findings on their colonoscopy (n = 585, median age 64 years). Results: Thirty-four percent of the patients (n = 202) with normal colonoscopy had elevated FC (>50 μg/g), and these patients were more frequently diagnosed with upper GI disease during the follow-up period than patients with normal FC levels (9.9 vs. 4.7%; p = 0.015). The upper GI diseases were mainly benign (i.e., gastritis). In a binary logistic regression analysis controlling for age, gender, nonsteroid anti-inflammatory drug use, and proton-pump inhibitor use, there was no difference for a new diagnosis of upper GI disease in the follow-up period (multivariate OR 1.70; 95% CI: 0.77–3.74). There was no difference in a new diagnosis of lower GI disease (6.4 vs. 5.2%; p = 0.545) or cardiovascular disease/death (multivariate OR 1.68; 95% CI: 0.83–3.42) in the follow-up period between patients with elevated versus normal FC levels. Conclusions: In patients with a normal colonoscopy, a simultaneously measured increased FC level was not associated with an increased risk for significant GI disease during a follow-up period of 3 years.

Rectal bleeding in children – case report

Intestinal polyps are tumoral masses protruding in the gas­tro­in­tes­tinal lumen, with various histopathological pat­terns, either as neoplastic or non-neoplastic type, and epi­th­e­lial or non-epithelial type. The classical form of cli­ni­cal presentation is rectal bleeding, with or without mu­cus, in a normal appearing stool, and only in a minority of cases there is lower abdominal pain. The standard pro­ce­dure for diagnosis and management of pediatrics co­lo­rec­tal po­lyps is full colonoscopy. Recent studies have re­vealed high levels of fecal calprotectin in patients with in­tes­ti­nal po­lyps and modern sonography empowered the detection rate of colonic polyps before performing co­lo­no­sco­py. We re­port the case of a 5-year-old boy who was refereed to our gastroenterology unit with a history of one month of in­ter­mit­tent rectal bleeding and mild ab­do­mi­nal pain, with an unremarkable medical history, and with nor­mal phy­si­cal and biochemical exam. The abdominal ultra­sound showed abundant blood flow signal in a round pe­dun­­cu­la­ted shaped intraluminal mass situated in the lower left ab­do­men area, measuring 20/15 mm. The co­lo­no­sco­py re­vealed a pedunculated left colon polyp that was re­moved using electroresection. The aim of this report is to draw at­ten­tion to the importance of hematochezia in chil­dren and to the need for adherence to actual guidelines re­gar­ding the endoscopic evaluation of the gastrointestinal tract in chil­dren.

Evaluation of Calprotectin Levels in First-Degree Relatives of Patients with Ulcerative Colitis

Recent studies have shown the diagnostic value of fecal as well as serum calprotectin in predicting the severity and activity of inflammatory bowel disease. Given the strong familial and inherited predisposition to inflammatory bowel disease, it is assumed that changes in calprotectin levels are also influenced by familial predispositions. Therefore, the present study aimed to evaluate the level of fecal calprotectin in patients and their first-degree relatives in order to determine the relationship between changes in this marker and its possible familial orientation. The study participants were the first-degree relatives (n = 100) of the patients (n = 33) with the definitive diagnosis of ulcerative colitis who referred to Rasoul-e-Akram hospital in 2018 and 2019. The fecal value of calprotectin was assessed using the ELISA method in both patients and the relatives. Fecal calprotectin level in patients was estimated to be 232.09±44.16μg/g. Fecal calprotectin level in the parents was 86.06±12.66μg/g, in siblings was 58.02±7.24μg/g and in the patient's children was 47.40±4.77μg/g. Fecal calprotectin levels were not affected by baseline indices such as gender, age, or BMI (either in patients or their relatives) and therefore these baseline factors had no effect on fecal calprotectin levels. Although fecal calprotectin levels are significantly longer in patients with ulcerative colitis than in healthy controls, the higher level of this marker among first-degree relatives of patients than healthy individuals also indicates the inherited tendency of changes in this marker in terms of high risk of disease in first-degree relatives of patients. These changes in fecal calprotectin levels will be independent of gender, age, and BMI

The Role of Fecal Calprotectin in Patients with Systemic Sclerosis and Small Intestinal Bacterial Overgrowth (SIBO).

Fecal calprotectin (FC) is a quick, cost-effective, and noninvasive test, which is used to diagnose patients with active inflammatory bowel diseases (IBD). Recent studies suggest the possible predictive role of FC in the diagnosis of small intestinal bacterial overgrowth (SIBO) in patients with systemic sclerosis (SSc). This study aimed to assess the predictive value of FC in SSc patients and its’ possible use as a SIBO marker. A total of 40 SSc patients and 39 healthy volunteers were enrolled in the study. All subjects completed questionnaires evaluating gastrointestinal symptoms, FC measurements, and lactulose hydrogen breath test (LHBT) assessing SIBO presence. After rifaximin treatment, patients with SIBO underwent the same diagnostic procedures. Significantly higher FC values were observed in the study group compared to controls (97 vs. 20 μg/g; p < 0.0001) and in SSc patients diagnosed with SIBO compared to SSc patients without SIBO (206 vs. 24 μg/g; p = 0.0010). FC turned out to be a sensitive (94.12%) and specific (73.68%) marker in the detection of SIBO in patients with SSc (AUC = 0.82, 95% CI = 0.66–0.93; p < 0.0001). Our study suggests the potential value of FC in SSc in detecting gastrointestinal impairment and its promising role as an additional diagnostic tool for SIBO.

Relationship between faecal calprotectin and inflammation in peripheral joints and entheses in axial spondyloarthritis

Objectives: To compare faecal calprotectin levels according to the type of manifestation and to investigate factors associated with increases in faecal calprotectin in patients with axial spondyloarthritis (axSpA). Method: The study enrolled 190 patients fulfilling the imaging arm of the Assessment of SpondyloArthritis international Society axSpA criteria. Faecal calprotectin levels were measured in an enzyme-linked immunosorbent assay. Systemic inflammatory markers and the Ankylosing Spondylitis Disease Activity Score (ASDAS) were also assessed. Peripheral joint involvement was assessed using the 44-joint examination and Spondyloarthritis Research Consortium of Canada Enthesitis Index. Results: Of 190 patients, 34 (18%) had increased faecal calprotectin levels. These patients were more likely to have ongoing peripheral arthritis and enthesitis (p = 0.016 and 0.001, respectively). A history of psoriasis and uveitis, or current uveitis symptoms, had no bearing on faecal calprotectin levels. Faecal calprotectin levels increased along with ASDAS–C-reactive protein (CRP), and correlated with ASDAS–erythrocyte sedimentation rate (ESR) (r = 0.240, p = 0.001), ASDAS-CRP (r = 0.162, p = 0.025), ESR (r = 0.228, p = 0.002), and CRP levels (0.258, p < 0.001). Tender joint and swollen joint counts also correlated with faecal calprotectin levels (r = 0.252 and 0.205, p < 0.001 and p = 0.005, respectively). Faecal calprotectin levels were higher in patients with current peripheral symptoms (p = 0.003). Peripheral symptoms were independently associated with increased faecal calprotectin levels (odds ratio = 4.083; 95% confidence interval 1.580–10.556). Conclusions: Faecal calprotectin levels in axSpA patients were associated with disease activity. Subclinical gut inflammation (assessed by measuring faecal calprotectin) in axSpA is more closely related to peripheral joint inflammation than to axial joint inflammation.

P236 The level of faecal calprotectin in patients with cystic fibrosis in the Krasnoyarsk region

P236 The level of faecal calprotectin in patients with cystic fibrosis in the Krasnoyarsk region