Role Of Fecal Calprotectin Research Articles

P233 Early measurement of fecal calprotectin after intestinal resection is useful to predict postoperative recurrence in patients with Crohn's disease

Background: Serological Inflammatory markers can be used for assisting in the diagnoses of inflammatory bowel disease but are neither particularly sensitive nor specific. Aim of this study is to investigate the role of fecal Calprotectin in the diagnosis of inflammatory bowel disease along with the serological markers ESR, CRP and endoscopic and radiological means. Methods: Retrospective data of Fecal Calprotectin was collected from the online portal of Kings College Pathology Laboratory London, along with blood and colonoscopy reports from the iLab and Unisoft software of the Mid Western Regional Hospital Limerick respectively over period of 18 months. Statistical analysis was performed using Chi square and Student’s T test on SPSS. A P-value of 0.05 was taken as significant. Results: In the 18 months 97 patients had their faecal Calprotectin checked. Fifty-two (53.6%) of them subsequently had the diagnosis of inflammatory bowel disease made on the basis of colonoscopy, CT scan abdomen or small bowel follow through. We divided patients into 2 groups on the basis of faecal Calprotectin values. Patients in group 1 faecal Calprotectin values less than 60 (n = 27) group 2 had values above 60 to 2009 (70). Of those with normal faecal Calprotectin 21 did not have a diagnosis of IBD, whilst 6 had, of those with elevated faecal Calprotectin 23 did not have a diagnosis of IBD, whilst 47 did (Chi square test, p = 0.001). Six (22%) of group 1 had colitis while nineteen (27%) of group 2 were normal. Mean ESR in group 1 was 11.38 VS 17.65 in group 2 (P= 0.159 Student T Test) while mean CRP in group 1 was 10.6 VS 6.4 in group 2 (P= 0.226 Student T test). Those patients with subsequent diagnosis of IBD (52) had a mean faecal Calprotectin of 335.89 VS non IBD patients (45) mean faecal Calprotectin value was 138 (P= 0.0059 Student T test). Conclusions: This study shows that the use of faecal Calprotectin is a reliable indicator of IBD in the Irish population studied. It also shows that ESR and CRP levels do not correlate with or assist in the diagnosis of IBD in this population.

P232 Evaluation of the use of fecal calprotectin as a diagnostic aid for IBD in an Irish population

Background: Serological Inflammatory markers can be used for assisting in the diagnoses of inflammatory bowel disease but are neither particularly sensitive nor specific. Aim of this study is to investigate the role of fecal Calprotectin in the diagnosis of inflammatory bowel disease along with the serological markers ESR, CRP and endoscopic and radiological means. Methods: Retrospective data of Fecal Calprotectin was collected from the online portal of Kings College Pathology Laboratory London, along with blood and colonoscopy reports from the iLab and Unisoft software of the Mid Western Regional Hospital Limerick respectively over period of 18 months. Statistical analysis was performed using Chi square and Student’s T test on SPSS. A P-value of 0.05 was taken as significant. Results: In the 18 months 97 patients had their faecal Calprotectin checked. Fifty-two (53.6%) of them subsequently had the diagnosis of inflammatory bowel disease made on the basis of colonoscopy, CT scan abdomen or small bowel follow through. We divided patients into 2 groups on the basis of faecal Calprotectin values. Patients in group 1 faecal Calprotectin values less than 60 (n = 27) group 2 had values above 60 to 2009 (70). Of those with normal faecal Calprotectin 21 did not have a diagnosis of IBD, whilst 6 had, of those with elevated faecal Calprotectin 23 did not have a diagnosis of IBD, whilst 47 did (Chi square test, p = 0.001). Six (22%) of group 1 had colitis while nineteen (27%) of group 2 were normal. Mean ESR in group 1 was 11.38 VS 17.65 in group 2 (P= 0.159 Student T Test) while mean CRP in group 1 was 10.6 VS 6.4 in group 2 (P= 0.226 Student T test). Those patients with subsequent diagnosis of IBD (52) had a mean faecal Calprotectin of 335.89 VS non IBD patients (45) mean faecal Calprotectin value was 138 (P= 0.0059 Student T test). Conclusions: This study shows that the use of faecal Calprotectin is a reliable indicator of IBD in the Irish population studied. It also shows that ESR and CRP levels do not correlate with or assist in the diagnosis of IBD in this population.

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.

Functional and organic abdominal pain: Role of fecal calprotectin and common serum markers in the differential diagnosis

Background: Fecal calprotectin (FC) has recently been investigated as a biological marker of intestinal inflammation, mainly in inflammatory bowel disease (IBD); however, few studies investigated its potential role in other pediatric gastroenterologic diseases.

Tu1111 A Prospective Evaluation of the Predictive Value of Faecal Calprotectin in Quiescent Crohn's Disease

Introduction Studies have suggested that faecal calprotectin (FC) levels may increase early in inflammatory bowel disease relapse before the patient is symptomatic and thus may be useful to identify patients at a higher risk of relapsing. The purpose of this study was to evaluate the role of FC in predicting relapse in patients followed up for a minimum of 12 months and to ascertain the best cut-off for this in our cohort of adult patients with quiescent Crohn’s disease (CD). Methods Patients with CD in clinical remission were recruited and followed up prospectively for a minimum of 12 months. Participants provided stool for FC concentration analysis and the study was terminated once the last recruited patient reached a follow up period of 365 days. Remission was defined as a Crohn’s disease activity index (CDAI) of Results 98 patients were recruited. One patient was lost to follow up, 1 died and the care of 3 patients was transferred to another centre, before either relapsing or being followed up for 12 months. Of the 93 remaining patients 11 (12%) had relapsed by 12 months. The median FC was lower for non-relapsers, 96 µg/g (IQR 39–237), than for relapsers, 328 µg/g (IQR 189–574), (p = 0.008). The area under the ROC curve to predict relapse using FC was 74.8% (Figure 1). A cut-off FC value of 240 µg/g to predict relapse of quiescent Crohn’s disease over the course of one year was associated with a sensitivity of 72.7% and specificity of 74.3%. Negative predictive value was high at 95.3% and positive predictive value was 27.6%.There was a significant difference in time to relapse for those with the first FC value below or above 240 µg/g (p = 0.011). Conclusion In this prospective dataset, FC appears to be a useful, non-invasive tool to help identify quiescent Crohn’s disease patients at a low risk of relapse over the ensuing 12 months. A FC value of 240 µg/g was deemed the best cut-off value in our patients. Disclosure of Interest None Declared.

Su1228 Thiopurine Withdrawal for Sustained Remission in IBD: A UK Multicentre Study

Introduction Thiopurine therapy is effective in maintaining clinical remission in IBD. However, long-term therapy is associated with an increased risk of lymphoma; therefore in clinical practise it may be appropriate to withdraw thiopurines after prolonged remission. Nevertheless, many patients will experience disease relapse within 12 months of drug withdrawal. The Aim of the present study was to retrospectively determine the relapse rate in ulcerative colitis (UC) and Crohn’s disease (CD) following azathioprine (AZA) or mercaptopurine (MP) withdrawal and to determine factors predictive of relapse. Methods Patients were identified by electronic case note review of IBD patients in eight major centres around the United Kingdom. Major inclusion criteria were AZA and/or MP therapy for a minimum of 3 years, AZA/MP withdrawn due to sustained clinical remission no steroid therapy for 6 months prior to drug withdrawal, and minimum 12 months follow-up. The primary outcome was disease relapse requiring AZA reinitiation, steroids or colectomy within 12 months of AZA/MP withdrawal, with secondary outcome assessed at 24 months. Clinical/laboratory predictors of relapse were sought. Results Data was obtained on 97 patients with CD and 78 with UC. Median age at diagnosis was 26y (interquartile range [IQR] 20–38), and 49% were female. Median duration of thiopurine use was 73 months (IQR 54–104). Median duration of follow-up was 39 months (IQR 24–65 months). CD was associated with a significantly higher risk of relapse than UC on Kaplan Meier analysis (Figure 1, p = 0.024). The moderate-severe relapse rate for 12 months was 27% for CD and 14% for UC. For 24 months, relapse rates were 41% for CD and 28% for UC. Elevated CRP was predictive of relapse at 12 months for CD (0 = 0.017), while elevated platelet count was predictive of relapse at 24 months for UC (0.021). Retreatment with a thiopurine after relapse was successful in 34/39 (87%) for CD and 17/18 (94%) cases for UC. Conclusion Relapse rates after withdrawal of a thiopurine are high, particularly for CD, and predicting this remains difficult. The findings regarding CRP and CD in this data highlight the importance of ensuring patients are in deep remission prior to drug withdrawal. Further studies should evaluate the role of faecal calprotectin in this. Disclosure of Interest None Declared.

Su1229 Predictors of Response to Infliximab As Salvage Therapy for Severe Steroid Refractory Ulcerative Colitis

G A A b st ra ct s therapy for 6 months prior to drug withdrawal, and minimum 12 months follow-up. The primary outcome was disease relapse requiring AZA reinitiation, steroids or colectomy within 12 months of AZA/MP withdrawal, with secondary outcome assessed at 24 months. Clinical/ laboratory predictors of relapse were sought. Results Data was obtained on 97 patients with CD and 78 with UC. Median age at diagnosis was 26y (interquartile range [IQR] 20-38), and 49% were female. Median duration of thiopurine use was 73 months (IQR 54-104). Median duration of follow-up was 39 months (IQR 24-65 months). CD was associated with a significantly higher risk of relapse than UC on Kaplan Meier analysis (Figure 1, p=0.024). The moderate-severe relapse rate for 12 months was 27% for CD and 14% for UC. For 24 months, relapse rates were 41% for CD and 28% for UC. Elevated CRP was predictive of relapse at 12 months for CD (0=0.017), while elevated platelet count was predictive of relapse at 24 months for UC (0.021). Retreatment with a thiopurine after relapse was successful in 34/39 (87%) for CD and 17/18 (94%) cases for UC. Conclusion Relapse rates after withdrawal of a thiopurine are high, particularly for CD, and predicting this remains difficult. The findings regarding CRP and CD in this data highlight the importance of ensuring patients are in deep remission prior to drug withdrawal. Further studies should evaluate the role of faecal calprotectin in this.

Role of Fecal Calprotectin in Differentiating between Hirschsprung's Disease and Functional Constipation

Calprotectin is a 36.5 kD calcium and zinc binding protein in the S100 protein family. Fecal calprotectin levels are elevated in patients with inflammatory bowel disease and some other gastrointestinal disorders such as colorectal carcinoma. We decided to evaluate the fecal calprotectin level to see if it was able to distinguish between functional and organic causes of constipation. Seventy-six children aged 1 to 120 months that all underwent deep rectal mucosa biopsies at Children Medical Center from November 2010 till September 2011 were recruited. Nineteen cases were diagnosed as Hirschsprung's disease and 57 of the patients had nerve ganglion cells in their biopsies. Calprotectin concentration was analyzed by the ELISA method. Although there was a significant difference between the median of the two groups (p=0.036), the median was not above the predetermined cutoff value of 50 µg/g. We propose that fecal calprotectin, using the above cutoff value, has limited value in differentiating functional constipation from Hirschsprung's disease.

The role of fecal calprotectin and lactoferrin in the diagnosis of necrotizing enterocolitis

Early detection of necrotizing enterocolitis can improve the prognosis, however, there is not a reliable laboratory test to detect either newborns at risk for necrotizing enterocolitis development or those at early stages of the disease. Since fecal lactoferrin and fecal calprotectin are inflammatory markers of gastrointestinal diseases, it was hypothesized that both these biomarkers could be successfully used in the diagnosis of necrotizing enterocolitis. In a prospective study, fecal lactoferrin and fecal calprotectin concentrations of 14 newborns with necrotizing enterocolitis and consecutively admitted 40 healthy preterm, and 23 healthy full-term newborns were measured with enzyme-linked immunosorbent assay technique. Mean fecal lactoferrin and fecal calprotectin were not different between preterm and full-term newborns (p = .235 and p = .845, respectively), or those who were diagnosed with necrotizing enterocolitis or not (p = .545 and p = .968, respectively). Prevalence of necrotizing enterocolitis was 1.51% (14 of 2734). Stage of the disease did not have a statistical effect on mean levels (p = .694 and p = .267, respectively). Mean fecal lactoferrin and fecal calprotectin levels were not different in the case of breastfeeding (p = .623 and p = .792, respectively). Neither fecal lactoferrin nor fecal calprotectin has a role in the identification of necrotizing enterocolitis, especially in early stages of the disease. Further studies on wider necrotizing enterocolitis series are needed for a more definite conclusion.

The role of faecal calprotectin in IBD

Gastrointestinal NursingVol. 10, No. 4 Conference ReportThe role of faecal calprotectin in IBDAndrew MilestoneAndrew MilestoneSearch for more papers by this authorAndrew MilestonePublished Online:16 Aug 2013https://doi.org/10.12968/gasn.2012.10.4.22bAboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Costa F, Mumolo MG, Ceccarelli L et al. (2005) Calprotectin is a stronger predictive marker of relapse in UC than in Crohn's disease. Gut 54: 364–8 Crossref, Google ScholarTibble J, Teahon K, Thjodleifsson B et al. (2000) IBD: a simple method for assessing intestinal inflammation in Crohn's disease. Gut 47: 506–13. doi:10.1136/gut.47.4.506 Crossref, Google Scholarvan Rheenen PF, Van de Vijver E, Fidler V(2010) Faecal calprotectin for screening of patients with suspected inflammatory bowel disease. BMJ 341: c3369. doi: 10.1136/bmj. c3369 Google Scholar FiguresReferencesRelatedDetails 1 May 2012Volume 10Issue 4ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 16 August 2013 Published in print 1 May 2012 Information© MA Healthcare LimitedPDF download

M1256 The Relationship Between Abdominal Fat Amount and the Diverticular Disease

Aim. The aim of this study was to assess the role of fecal calprotectin (FC) in diagnosis of complicated colonic diverticular disease (DD) and to compare it with uncomplicated colonic DD and matched controls. Methods. We studied 57 consecutive patients with a new endoscopic diagnosis of colonic diverticulosis (45 with asymptomatic uncomplicated DD, and 12 with acute diverticulitis) and 25 healthy controls. The level of FC was measured in every case by a semiquantitative test with three categories of results: type 1 (under 15 μg/g), type 2 (15-60 μg/g), and type 3 (more than 60 μg/g). The results were correlated with the degree of histological inflammation of colonic mucosa that was assessed by the degree of lymphocytic cell density. Results. We found higher FC values in acute uncomplicated diverticulitis (p<0.05) than in asymptomatic uncomplicated DD and in healthy controls. There were no differences between uncomplicated colonic DD and healthy controls. FC values increase according to the increase of lymphocytic cell density, showing a statistically significant correlation (p<0. 05). Patients with acute diverticulitis were treated with antibiotics for 10 days; in these patients, reassessment of FC after three months revealed a significant decrease comparingwith the initial level. Conclusions. FCmay be useful to detect colonic inflammation in DD and in distinguishing acute diverticulitis from uncomplicated colonic DD and healthy controls. Also, FC may be useful for follow-up after treatment.

Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease

Faecal calprotectin has been proposed as a non-invasive surrogate marker of intestinal inflammation in inflammatory bowel disease. Close correlation between faecal calprotectin concentration and faecal leukocyte excretion quantified with (111)indium has been described. This faecal marker can be detected using simple and cheap techniques. Faecal calprotectin has a good diagnostic precision for separating organic and functional intestinal diseases. However, the specificity for the diagnosis of inflammatory bowel disease is lower than desirable, as several diseases other than inflammatory bowel disease -- specially colorectal neoplasia and gastrointestinal infection -- can also increase faecal calprotectin. High concentration of calprotectin in faeces is a strong argument to carry out a colonoscopy in order to rule out the presence of inflammatory bowel disease or other organic pathologies. Parallelism between faecal calprotectin levels and inflammatory bowel disease activity has been confirmed, although this faecal marker appears to better reflect the disease activity in ulcerative colitis than in Crohn's disease. Faecal calprotectin's capacity to predict inflammatory bowel diseases relapse is promising. It has been suggested that, in inflammatory bowel disease patients receiving treatment, a normalization or decrease in faecal calprotectin concentrations is an accurate indicator of endoscopic healing. Greater faecal calprotectin concentration has been shown in asymptomatic first-degree relatives of patients with inflammatory bowel disease, suggesting that there is a high prevalence of subclinical intestinal inflammation in them.

Role of faecal calprotectin as non-invasive marker of intestinal inflammation.

Faecal calprotectin, a neutrophil granulocyte cytosol protein, is considered a promising marker of intestinal inflammation. We assessed and compared the faecal calprotectin concentration in patients with organic and functional chronic intestinal disorders. The study was carried out, using a commercially available ELISA test, measuring calprotectin in stool samples collected from 131 patients with inflammatory bowel diseases, 26 with intestinal neoplasms, 48 with irritable bowel syndrome and 34 healthy subjects. Median faecal calprotectin was significantly increased in Crohn's disease (231 microg/g, 95% confidence interval (CI) 110-353 microg/g), ulcerative colitis (167 microg/g, 95% CI 59-276 microg/g), and neoplasms (105 microg/g, 95% CI 0-272 microg/g), whereas normal values were found in patients with irritable bowel syndrome (22 microg/g, 95% CI 9-35 microg/g) and in healthy subjects (11 microg/g, 95% CI 3-18 microg/g). A positive correlation was observed with clinical activity scores in Crohn's disease and ulcerative colitis. In both groups, patients with clinically active disease showed higher calprotectin levels than those observed in patients with quiescent disease (405 microg/g, 95% CI 200-610 microg/g vs. 213 microg/g, 95% CI 85-341 microg/g in CD patients, p<0.05, and 327 microg/g, 95% CI 104-550 microg/g vs. 123 microg/g, 95% CI 40-206 microg/g in UC patients, p<0.001). Faecal calprotectin appears to be a promising and non-invasive biomarker of intestinal inflammation. If these findings are confirmed, it may provide a useful test for the diagnosis and follow up of inflammatory bowel diseases.