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Updated: May 4, 2026
Investigating Intestinal Inflammation in DSS-induced Model of IBD
Published on: February 1, 2012
Fecal hemoglobin and calprotectin are equally effective in identifying patients with inflammatory bowel disease with
Erik Mooiweer1, Herma H Fidder, Peter D Siersema
1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Fecal hemoglobin is a useful noninvasive marker for detecting active inflammation in inflammatory bowel disease (IBD) patients, with accuracy comparable to fecal calprotectin. This finding offers a valuable alternative for monitoring IBD activity.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Biomarker Discovery
Background:
- Fecal calprotectin is a noninvasive marker for assessing inflammation in inflammatory bowel disease (IBD).
- The diagnostic accuracy of fecal calprotectin is considered modest, necessitating the search for additional or alternative markers.
- This study aimed to compare fecal hemoglobin and calprotectin as markers for endoscopic inflammation in IBD patients.
Purpose of the Study:
- To evaluate the efficacy of fecal hemoglobin as a noninvasive marker for endoscopic inflammation in IBD.
- To compare the diagnostic accuracy of fecal hemoglobin against fecal calprotectin.
- To determine optimal cutoff values for both markers in identifying endoscopic inflammation.
Main Methods:
- 176 surveillance colonoscopies were performed in 164 IBD patients (Crohn's disease, ulcerative colitis).
- Fecal samples were collected pre-colonoscopy for analysis of calprotectin and hemoglobin using ELISA.
- Receiver operator characteristic (ROC) statistics were employed to establish cutoff values and assess predictive accuracy.
Main Results:
- Fecal calprotectin (cutoff 140 mg/kg) showed 86% sensitivity and 72% specificity (AUC 0.87).
- Fecal hemoglobin (cutoff 1.51 μg/g) demonstrated 74% sensitivity and 84% specificity (AUC 0.81).
- Combining both markers did not significantly enhance predictive accuracy over individual tests (AUC 0.88).
Conclusions:
- Fecal hemoglobin serves as an effective noninvasive biomarker for identifying active inflammation in IBD patients.
- The predictive accuracy of fecal hemoglobin is comparable to that of fecal calprotectin.
- Fecal hemoglobin presents a viable alternative marker for IBD inflammation assessment.
Background:
Fecal calprotectin can be used as a noninvasive tool to assess inflammation in patients with inflammatory bowel disease (IBD). However, the diagnostic accuracy of calprotectin is modest, and therefore additional markers are needed. We compared the efficacy of fecal hemoglobin and calprotectin as markers for endoscopic inflammation in patients with IBD.
Methods:
Consecutive patients with Crohn's disease or ulcerative colitis scheduled for surveillance colonoscopy collected a stool sample before bowel preparation. Experienced endoscopists assessed the presence of inflammation in each colonic segment. Fecal calprotectin and hemoglobin were analyzed with an enzyme-linked immunosorbent assay. Receiver operator characteristic statistics were used to determine cutoff values for calprotectin and hemoglobin.
Results:
A total of 176 surveillance colonoscopies were performed in 164 patients, of which 83 patients had Crohn's disease, 74 had ulcerative colitis, and 7 IBD-unclassified. Median (interquartile range) calprotectin and hemoglobin concentrations were 137 mg/kg (interquartile range, 33-494) and 0.51 μg/g (interquartile range, 0.18-8.50), respectively. For calprotectin, a cutoff value of 140 mg/kg predicted endoscopic inflammation with 86% sensitivity, 72% specificity, 64% positive predictive value, 90% negative predictive value, and an area under the curve of 0.87. For hemoglobin, a cutoff value of 1.51 μg/g indicated endoscopic inflammation with 74% sensitivity, 84% specificity, 72% positive predictive value, 84% negative predictive value, and an area under the curve of 0.81. Combining both tests did not increase the predictive accuracy substantially compared with calprotectin or hemoglobin alone (area under the curve, 0.88).
Conclusions:
Fecal hemoglobin can identify patients with IBD with active inflammation with a predictive accuracy similar to calprotectin.
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