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Correlation Between Calprotectin and Modified Rutgeerts Score.

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Fecal calprotectin and lactoferrin effectively predict Crohn's disease recurrence after surgery. Using the modified Rutgeerts score improves accuracy in diagnosing endoscopic recurrence compared to the standard Rutgeerts score.

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Area of Science:

  • Gastroenterology
  • Inflammatory Bowel Disease Research
  • Surgical Outcomes

Background:

  • Endoscopic recurrence is common after Crohn's disease surgery and indicates prognosis.
  • Fecal markers like calprotectin (FC) and lactoferrin (FL) show promise for postoperative monitoring.
  • Accurate diagnosis of recurrence is crucial for timely intervention.

Purpose of the Study:

  • To evaluate the accuracy of fecal calprotectin (FC) and lactoferrin (FL) in diagnosing endoscopic recurrence (ER) after ileocolonic resection for Crohn's disease.
  • To compare the diagnostic performance of FC and FL using the modified Rutgeerts score (MRS) versus the standard Rutgeerts score (RS).

Main Methods:

  • Prospective cohort study of 99 patients undergoing ileocolonic resection for Crohn's disease.
  • Fecal markers (FC, FL), clinical indexes, and biomarkers collected on the day of ileocolonoscopy.
  • Endoscopic recurrence (ER) defined by MRS (≥ i2b) or RS (≥ i2).

Main Results:

  • FC and FL levels were significantly higher in patients with ER than in remission (P < 0.001 for both).
  • The modified Rutgeerts score (MRS) identified ER in 34% of patients, versus 76% with the standard Rutgeerts score (RS).
  • MRS demonstrated higher accuracy (75% vs. 55%), sensitivity, and negative predictive value for both FC and FL compared to RS.

Conclusions:

  • Fecal calprotectin (FC) and lactoferrin (FL) correlate well with endoscopic findings in postoperative Crohn's disease.
  • These fecal markers predict recurrence more accurately when assessed with the modified Rutgeerts score (MRS).
  • Fecal markers can guide monitoring for disease recurrence post-resection, aiding selection for endoscopic evaluation.