Review article: faecal calprotectin and histologic remission in ulcerative colitis

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Clinical Biomarker Development

Background:

• Histologic healing is a key therapeutic target in ulcerative colitis (UC), but current assessment methods involve invasive procedures like endoscopy and biopsies.
• Faecal calprotectin offers a non-invasive alternative for monitoring mucosal healing in UC patients.

Purpose of the Study:

• To systematically review and clarify the correlation between faecal calprotectin levels and histologic activity in patients diagnosed with UC.

Main Methods:

• A comprehensive literature search was conducted across PubMed/MEDLINE, EMBASE, and Web of Science up to September 2019.
• Included studies focused on UC patients with confirmed diagnoses, reporting on the correlation between faecal calprotectin levels and histologic analysis.
• Twelve studies involving 1168 patients were analyzed.

Main Results:

• All twelve included studies demonstrated a clear correlation between faecal calprotectin levels and histologic findings in UC.
• Histologic remission definitions varied, with five studies using non-validated scores and seven using partially validated scores.
• Eleven distinct faecal calprotectin cut-off values (ranging from 40.5 to 250 μg/g) were identified to differentiate histologic remission from activity.

Conclusions:

• Faecal calprotectin is a promising non-invasive biomarker for predicting histologic remission in UC.
• Variability in assay kits and histologic remission definitions contributes to the wide range of identified faecal calprotectin cut-off levels.
• Further large-scale prospective studies employing validated histologic indexes are necessary to establish a universally accepted faecal calprotectin cut-off for clinical practice.