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Association of Fecal Calprotectin With Endoscopic and Histologic Activity in Pediatric Inflammatory Bowel Disease
Erin Crawford1, Catherine Gestrich2, Sindhoosha Malay3
1From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UH/Rainbow Babies and Children's Hospital, Cleveland OH.
Insights
Fecal calprotectin (FC) levels correlate with inflammatory bowel disease (IBD) activity. Higher FC values indicate more severe endoscopic and histologic disease, suggesting FC is a useful noninvasive marker for assessing IBD severity.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Inflammatory Bowel Disease Research
Background:
- Fecal calprotectin (FC) is a validated noninvasive biomarker for intestinal inflammation.
- Its utility in correlating specific FC values with objective measures of disease activity in inflammatory bowel disease (IBD) requires further elucidation.
- Understanding this association is crucial for effective IBD screening and monitoring.
Purpose of the Study:
- To investigate the association between fecal calprotectin (FC) levels and the endoscopic and histologic severity of inflammatory bowel disease (IBD).
- To determine if FC values can accurately reflect disease activity in IBD patients.
Main Methods:
- Retrospective chart review of 331 patients, including 107 with IBD, who underwent colonoscopy.
- FC levels were measured within 30 days prior to colonoscopy.
- Endoscopic severity was assessed using the Simple Endoscopic Score for Crohn's disease or Mayo endoscopic score for ulcerative colitis, and histologic severity was graded using the Geboes method.
Main Results:
- Median FC levels showed a significant linear increase with escalating endoscopic and histologic disease severity in IBD patients.
- For endoscopy, median FC ranged from 181 μg/g (no disease) to 921 μg/g (severe disease).
- For histology, median FC ranged from 328 μg/g (no disease) to 895 μg/g (severe disease).
- IBD patients in endoscopic remission had significantly higher median FC (181 μg/g) compared to controls (35.5 μg/g).
Conclusions:
- Fecal calprotectin (FC) values demonstrate a clear linear association with increasing endoscopic and histologic disease severity in patients with inflammatory bowel disease (IBD).
- FC levels in IBD patients achieving endoscopic remission were significantly higher than in the control population.
- FC serves as a valuable noninvasive tool for assessing disease severity in IBD.
Abstract:
Fecal calprotectin (FC) is a noninvasive marker of intestinal inflammation used for screening and ongoing monitoring of inflammatory bowel disease (IBD); it is unclear the association of specific FC values with disease activity. The aim of our study was to examine the association of FC values with endoscopic and histologic severity.
Methods:
We performed a retrospective chart review of patients who had FC done between 30 days and 1 day before colonoscopy at our institution. IBD patients were graded using the simple endoscopic score for Crohn's disease or Mayo endoscopic score for ulcerative colitis. Histologic slides were graded using the Geboes method.
Results:
Three-hundred thirty-one patients were included in the study and 107 had IBD. For endoscopy, median FC was lowest for all IBD patients with no disease (181 μg/g) and highest in severe disease (921 μg/g), with significant difference between no disease and moderate and severe disease (P = 0.019, 0.003), and between mild and severe disease (P = 0.012). For histology, median FC was lowest with no disease (328 μg/g) and highest in severe disease (895 μg/g), with significant difference between no disease and moderate and severe disease (P = 0.021, 0.018). The control population had a significantly lower median FC than the IBD population in endoscopic remission (35.5 versus 181 μg/g; P = 0.018).
Conclusions:
There was a linear increase in FC values associated with increasing disease severity in the undifferentiated IBD cohort. Values for IBD patients in endoscopic remission were significantly different from our control population. FC may be a useful noninvasive marker to assess disease severity.
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