Fecal Calprotectin Levels In Patients Research Articles

Validation of a point-of-care desk top device to quantitate fecal calprotectin and distinguish inflammatory bowel disease from irritable bowel syndrome

Background and aimsThe neutrophil protein calprotectin has been investigated as a surrogate marker for intestinal inflammation. This study was designed to contrast fecal calprotectin levels in patients with inflammatory and non-inflammatory intestinal diseases and to compare the results obtained from the standard ELISA-based method with those obtained from a novel desk-top device. MethodsSoluble proteins were extracted from stool samples of 50 participating patients, including those diagnosed with Ulcerative Colitis, Crohn's Disease or IBS, and volunteers with no known intestinal problems. Calprotectin was assessed in the extracted material using the “desk top” Bühlmann Quantum Blue Reader® or by standard ELISA techniques. ResultsThe mean concentration of calprotectin in the IBD patients group was significantly higher than the mean concentration found in IBS patients and healthy controls (p=0.01). Calprotectin concentrations in IBS patients and controls were indistinguishable. IBD patients that had undergone recent surgery displayed scores similar to controls and IBS patients. Excluding these patients yielded a specificity of 100% for results from both CD and UC patients and an accuracy rate of 1 for CD and 0.89 for UC patients in ROC analysis. Quantum Blue Reader® calprotectin levels were available within 30min and correlated well with results derived from standard ELISA assays, which took over 8h to complete. ConclusionOur results confirm the effective use of fecal calprotectin levels in differentiating non-inflammatory from active inflammatory intestinal diseases. The desk top Bühlmann Quantum Blue Reader® exhibits a fast, non-invasive, and reliable way of identifying an inflammatory intestinal disease.

Fecal calprotectin: A selection tool for small bowel capsule endoscopy in suspected IBD with prior negative bi-directional endoscopy

Background and aim. Fecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation with advocated diagnostic precision in distinguishing inflammatory bowel disease (IBD) from non-IBD diagnoses. FC correlates with abnormalities seen on small bowel barium radiology, but little data exist in relation with small bowel capsule endoscopy (SBCE). To investigate the value of FC as a selection tool for further investigation of the small bowel with SBCE, in a cohort of patients who had negative bi-directional endoscopies, but with continuing clinical suspicion of Crohn's disease (CD). Methods. We retrospectively correlated the findings of SBCE with FC levels in patients referred with clinical suspicion of CD and negative bi-directional endoscopies. Only patients with FC results prior to the SBCE test were included; in cases of multiple FC determinations, the value closest to the SBCE date was selected. Medications history including usage of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) was made available for all patients. SBCE findings were analyzed against final diagnosis and FC values. Results. Seventy adult patients were studied (53 females, 17 males). Three cases were excluded, due to capsule retention in the stomach. Median time from FC measurement to SBCE was 62 days. Twenty-three patients had normal FC (≤50 μg/g) and in all those the SBCE was normal. Forty-four patients had FC >50 μg/g; in this group, nine patients had FC between 51 and 100 μg/g and all had a normal SBCE. Thirty-five patients had FC levels >100 μg/g; of those, 15 (42.85%) had SBCE findings compatible with CD and mean FC levels 326 μg/g (range 116–1430 μg/g). A definitive clinical diagnosis of CD, based on subsequent follow-up, was made in 10/35 (28.5%) of patients. These 10 patients were within the subgroup of 15 patients with positive SBCE findings and had median FC levels 368 μg/g (range 235–1430 μg/g). Conclusions. Measurement of FC levels prior to referral for SBCE is a useful tool to select patients with possible small bowel CD. A FC >100 μg/g is good predictor of positive SBCE findings, while FC >200 μg/g was associated with higher SBCE yield (65%) and confirmed CD in 50% of cases. Patients with FC between 50 and 100 μg/g had normal SBCE, despite symptoms suggestive of IBD. In all patients with clinical suspicion of CD and negative bi-directional endoscopies, FC assessment should be carried out prior to their referral for SBCE. Where FC is <100 μg/g (NPV 1.0), SBCE is not indicated.

Fecal calprotectini in first degree relatives of patients with ulcerative colitis

The pathogenesis of inflammatory bowel disease seems to depend on the combination of genetic and environmental factors (1). To evaluate genetic susceptibility, one approach is to search for specific markers in apparently unaffected family members of patients (2). Our aim was to evaluate fecal calprotectin concentrations in first-degree relatives of patients with ulcerative colitis. Fifty-five patients with ulcerative colitis and 167 healthy first-degree relatives were recruited; 38 of the patients' spouses were also enrolled. One hundred and fifty healthy subjects participated as control group. Fecal calprotectin concentrations were determined by ELISA. Fecal calprotectin concentrations were compared among the groups by Kruskal-Wallis ANOVA test followed by Mann-Whitney U test. Significantly increased fecal calprotectin concentrations were found in first-degree relatives of patients with ulcerative colitis [76.0 (34.7-129.6) μg/g] as compared with controls [31.6 (17.0-45.0)] (p<0.0001). Fecal calprotectin levels in patients with ulcerative colitis [256.0 (153.0-356.0) μg/g] were significantly higher as compared with first-degree relatives, spouses [43.8 (18.6-89.0 μg/g)] and controls (p<0.0001 for all comparisons). FCC of relatives was significantly higher than FCC of spouses (p=0.01). FCC of spouses had a significantly higher FCC with respectto controls (p=0.01). First-degree relatives of patients with ulcerative colitis had increased FCC values and could have a subclinical intestinal inflammation. It needs to clarify if this finding is the consequence of genetic predisposition, of environmental factors or the interaction of both, and if relatives with high FCC have an increased risk of developing the disease.

Fecal Calprotectin Levels in Patients with Colonic Polyposis

The usefulness of stool calprotectin determination in diagnosis of inflammatory disease of the colon has been reported; information about its usefulness for patients with polyposis are scarce, however. To evaluate the significance of stool calprotectin concentrations for patients affected by colonic polyposis. Sixty-three consecutive patients (35 males, 28 females, mean age 60.3 years, range 39-78 years) were enrolled: 26 patients (41.3%) with polyps, 17 patients (27.0%) with asymptomatic diverticular disease, and 20 subjects (31.7%) with normal endoscopic appearance of the colon. Stool calprotectin concentrations were 17.4 +/- 24.5 microg g(-1) for patients with colonic polyposis, significantly higher than concentrations for patients with diverticulosis (7.1 +/- 5.7 microg g(-1); P = 0.026) or for patients with normal appearance of the colon (calprotectin 6.0 +/- 5.8 microg g(-1); P = 0.003). For patients with a single polyp, stool calprotectin concentrations were similar to those for patients with multiple polyps. Calprotectin fecal concentrations for patients with sessile polyps and those with flat polyps were not significantly different. Calprotectin concentrations were not significantly related to the size of the polyps. Our data show that colonic polyposis may cause an increase in stool calprotectin values and that these colonic lesions should be suspected when elevated stool calprotectin concentrations are found.

Diagnostic Precision of Fecal Calprotectin for Inflammatory Bowel Disease and Colorectal Malignancy

Fecal calprotectin (FC) is a relatively new marker of intraluminal intestinal inflammation. Using meta-analytical techniques, the study aimed to evaluate the diagnostic precision of FC for inflammatory bowel disease (IBD) and colorectal cancer (CRC) in adults and children. Quantitative meta-analysis was performed on prospective studies, comparing FC levels against the histological diagnosis. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study. Summary receiver-operating characteristic (sROC) curves and subgroup analysis were undertaken. Study quality and heterogeneity were evaluated. Thirty studies of 5,983 patients were included. FC levels in patients with IBD were higher by 219.2 micrograms per gram (microg/g) compared with normal patients (P < 0.001). sROC curve analysis showed a sensitivity of 0.95 (95% CI 0.93-0.97), specificity of 0.91 (95% CI 0.86-0.91), and an area under the curve (AUC) of 0.95 for the diagnosis of IBD. Patients with colorectal neoplasia had nonsignificantly higher FC levels by 132.2 microg/g compared with noncancer controls (P= 0.18). Sensitivity and specificity of FC for the diagnosis of CRC were 0.36 and 0.71, respectively, with an AUC of 0.66. The diagnostic precision of FC for IBD was higher in children than adults with better accuracy at a cutoff level of 100 microg/g versus 50 microg/g. Sensitivity analysis and metaregression analysis did not significantly alter the results. FC cannot be recommended as a screening test for CRC in the general population. FC appeared to offer a good diagnostic precision in distinguishing IBD from non-IBD diagnoses, with higher precision at a cutoff of 100 microg/g.

Fecal Calprotectin in First-Degree Relatives of Patients with Ulcerative Colitis

The pathogenesis of inflammatory bowel disease seems to depend on the combination of genetic and environmental factors. To evaluate genetic susceptibility, one approach is to search for specific markers in apparently unaffected family members of patients. Our aim was to evaluate fecal calprotectin concentrations (FCCs) in first-degree relatives of patients with ulcerative colitis (UC). Fifty-five patients with UC and 167 healthy first-degree relatives were recruited; 38 of the patients' spouses were also enrolled. One hundred fifty healthy subjects participated as the control group. FCCs were determined by ELISA. FCCs were compared among the groups by Kruskal-Wallis analysis of variance (ANOVA) test followed by Mann-Whitney U test. Significantly greater FCCs were found in first-degree relatives of patients with UC (76.0 [34.7-129.6] microg/g) as compared with controls (31.6 [17.0-45.0]) (P < 0.0001). Fecal calprotectin levels in patients with UC (256.0 [153.0-356.0] microg/g) were significantly higher as compared with first-degree relatives, spouses (43.8 [18.6-89.0] microg/g), and controls (P < 0.0001 for all comparisons). FCC of relatives was significantly higher than FCC of spouses (P = 0.01). FCC of spouses had a significantly higher FCC with respect to controls (P = 0.01). First-degree relatives of patients with UC had greater FCC values and could have a subclinical intestinal inflammation. It needs to be clarified if this finding is the consequence of genetic predisposition, of environmental factors, or the interaction of both, and if relatives with high FCC have a greater risk of developing the disease.

FECAL CALPROTECTIN DIFFERENTIATES BETWEEN CHILDREN WITH ACTIVE INFLAMMATORY BOWEL DISEASE (IBD) AND HEALTHY CHILDREN

Background: Calprotectin is a calcium- binding protein released by myelomonocytic cells during inflammation. Fecal calprotectin (FC) is elevated in patients with IBD and may fluctuate according to disease activity. Aims: 1) Compare levels of FC in healthy children to those with IBD. 2) Compare FC levels within the IBD group (flare vs. remission). Methods: FC was measured by ELISA using 134 stool samples (37 from healthy controls, 76 from Crohn disease (CD) patients and 21 from ulcerative colitis (UC) patients). Normal FC level was defined as <50 mcg/g of stool. Disease activity in 32 IBD patients (56 samples) was assessed by the physician global assessment within 2 weeks of sample submission. The Harvey-Bradshaw index (HBI) was calculated in CD patients. Analysis was performed using the Wilcoxon rank sum test. Results: See Table 1. As a group IBD patients had higher FC levels than healthy controls (p < 0.0001). Patients with active IBD had significantly higher FC levels than controls with no overlap in FC concentrations (p < 0.0001). FC levels were higher in disease flare than remission (p < 0.0001); however there was some overlap in FC levels (p < 0.0001). The correlation coefficient between the HBI and FC levels in patients with CD was 0.36, p < 0.02.Table 1Conclusions: FC levels can be used to differentiate children with active IBD from healthy controls. FC levels failed to clearly differentiate disease flare from remission in IBD patients. There is not a clear relationship between HBI and FC as a predictor of relapse. Further investigation of the predictive value of FC in determining relapse in a cohort with clinical remission is needed.

Clinical significance of faecal calprotectin levels in patients with ulcerative colitis

Clinical significance of faecal calprotectin levels in patients with ulcerative colitis