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Faecal calprotectin concentration in children with coeliac disease
Anna Szaflarska-Popławska1, Bartosz Romańczuk2, Monika Parzęcka1
1Department of Pediatric Endoscopy and Gastrointestinal Function Testing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
Insights
Faecal calprotectin concentration (FCC) did not prove useful for diagnosing or monitoring coeliac disease (CD) in children. Elevated FCC was observed in both newly diagnosed and treated CD patients, regardless of disease presentation or severity.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Gastroenterology
Background:
- The role of elevated fecal calprotectin (FC) in active untreated coeliac disease (CD) remains unclear.
- It is uncertain if elevated FC is solely due to CD or indicates co-existing gastrointestinal inflammation.
Purpose of the Study:
- To evaluate fecal calprotectin concentration (FCC) in children with CD.
- To correlate FCC with the clinical presentation and histopathological findings of the small intestine in pediatric CD patients.
Main Methods:
- Study included 55 children with newly diagnosed CD and 17 on a gluten-free diet.
- Clinical forms (classical, non-classical, asymptomatic) and Marsh classification of small intestinal lesions were assessed.
- Fecal calprotectin concentration (FCC) was measured using ELISA.
Main Results:
- Abnormal FCC was found in 38.2% of newly diagnosed CD patients and 35.3% of treated patients.
- No significant correlation was found between FCC and clinical presentation or Marsh grade in newly diagnosed CD.
- Mean FCC was similar between newly diagnosed (100.9 ±154.4 µg/g) and treated (61.8 ±106.2 µg/g) CD groups.
Conclusions:
- Fecal calprotectin concentration (FCC) is not a useful marker for diagnosing or monitoring coeliac disease (CD) in children.
- FCC assessment is not recommended regardless of the clinical form or severity of intestinal lesions in CD.
Introduction:
It is still unknown whether faecal calprotectin elevation may be caused by active untreated coeliac disease (CD) itself or whether it indicates the coexistence of CD and another disease associated with gastrointestinal inflammation.
Aim:
To assess faecal calprotectin concentration (FCC) and its correlation with the clinical form and histopathological picture of the small intestine in children with CD.
Material And Methods:
Fifty-five children with newly recognised CD (mean age: 9.1 years) and 17 children with CD diagnosed at least year before and on a strict gluten-free diet (mean age: 12.3 years) were accepted for the study. Classical (n = 27), non-classical (n = 17), and asymptomatic form (n = 11) were distinguished in children with newly diagnosed CD based on the clinical picture. The histopathological small intestinal lesions were classified as Marsh 1 (n = 4), 3a (n = 5), 3b (n = 20), and 3c (n = 26). FCC was assessed using ELISA method with 50 µg/g as the upper limit of the normal.
Results:
FCC was abnormal for 21 patients with newly diagnosed CD (38.2%) and for six patients from the treated group (35.3%). Mean FCC for the analysed group of patients was 91.7 ±144.8 µg/g, in the group with newly diagnosed CD - 100.9 ±154.4 µg/g, and in the treated group - 61.8 ±106.2 µg/g (Z = -1.333; p = 0.183). In the group of patients with recently diagnosed CD a statistically significant relationship was not observed for FCC and both clinical picture (χ2 = 0.319, p = 0.852) and severity of small intestinal lesions according to the Marsh classification (rho = 0.136).
Conclusions:
Assessment of FCC seems to have no use as a marker for diagnostics and monitoring of CD irrespective of clinical form of the disease and severity of the inflammatory lesions within the small intestine.
