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Fecal calprotectin concentration is increased in children with celiac disease: relation with histopathological
Necati Balamtekın1, Gökhan Baysoy, Nuray Uslu
1GATA, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara, Turkey. 20011975@mynet.com
Insights
Fecal calprotectin is elevated in newly diagnosed pediatric celiac disease patients and decreases with a gluten-free diet. This non-invasive marker aids in diagnosing celiac disease and monitoring treatment adherence.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Biomarker Research
Background:
- Celiac disease is an autoimmune disorder triggered by gluten ingestion.
- Accurate diagnosis and monitoring of treatment adherence are crucial in pediatric celiac disease.
- Fecal calprotectin is an established marker of intestinal inflammation.
Purpose of the Study:
- To compare fecal calprotectin levels in children with newly diagnosed celiac disease, treated celiac disease, and healthy controls.
- To correlate fecal calprotectin with clinical presentation and histopathological findings.
- To assess the impact of a gluten-free diet on fecal calprotectin levels.
Main Methods:
- Comparative study of three groups: untreated celiac disease, treated celiac disease, and healthy controls.
- Fecal calprotectin levels measured in all participants.
- Serial fecal samples collected from newly diagnosed patients after initiating a gluten-free diet.
Main Results:
- Fecal calprotectin was significantly higher in newly diagnosed celiac patients compared to treated patients and controls (p<0.001).
- Elevated levels correlated with gastrointestinal symptoms and Marsh grade.
- Fecal calprotectin levels decreased significantly after adherence to a gluten-free diet (p<0.01).
Conclusions:
- Increased fecal calprotectin is a valuable non-invasive marker for diagnosing pediatric celiac disease, particularly in those with GI symptoms.
- Fecal calprotectin normalizes with a strict gluten-free diet, indicating its utility in monitoring adherence and inflammation.
- This marker can help differentiate celiac disease from functional gastrointestinal disorders.
Background/Aims:
The aim of this study was to compare the fecal calprotectin concentration in children with newly diagnosed celiac disease, children with celiac disease strictly adhering to a gluten-free diet and healthy controls. We also tried to correlate the fecal calprotectin concentration with the clinical presentation, degree of neutrophilic infiltration and the severity of histopathological injury (Marsh grade) in the small bowel mucosa.
Material And Methods:
The study included three groups: children with untreated celiac disease, children with treated celiac disease, and healthy controls. Moreover, we obtained a second fecal sample from nine newly diagnosed children when their endomysial antibody became negative after gluten-free diet.
Results:
Fecal calprotectin concentrations were significantly higher in newly diagnosed celiac patients (n=31) compared to patients on gluten-free diet (n=33) and healthy controls (n=34) (117.2 μg/g (3.2-306) vs. 3.7 μg/g (0.5-58.2) and 9.6 μg/g (1-70), respectively, p<0.001). Patients presenting with gastrointestinal symptoms had higher fecal calprotectin concentration compared to the patients presenting with nongastrointestinal symptoms [142.8 (12.2-306) vs. 79.7 (3.2-243.2) respectively, p=0.04]. Nine newly diagnosed patients gave a second fecal sample after starting gluten-free diet when endomysial antibody became negative. Their fecal calprotectin concentration had decreased from 113.7 μg/g (8.7-295.2) to 4.2 μg/g (0.5-20.7) (p<0.01).
Conclusions:
Increased fecal calprotectin concentration can be used as a non-invasive marker that might aid in the diagnosis of celiac disease, especially in patients with gastrointestinal presentation. Fecal calprotectin concentration returns to normal on a strict gluten-free diet. Fecal calprotectin may be used as a marker of diet adherence and improvement in gastrointestinal inflammation in children with celiac disease. Additionally, it may be used for the differentiation of celiac disease from functional disorders of the gastrointestinal system.
