Faecal calprotectin to monitor response to treatment escalation for endoscopic postoperative recurrence of Crohn's...

Approximately 20% of the patients with Crohn's disease (CD) undergo intestinal resection within the first five years from diagnosis. Postoperative recurrence (POR) occurs in many even if preventive therapies are started early after surgery. In this scenario, treatment escalation is recommended; although scarce data are available, faecal calprotectin (FC) has been proposed as the best non-invasive monitoring tool. The aim of this study is to explore the utility of FC for monitoring the treatment response of endoscopic POR (ePOR).

A single-centre retrospective study of patients with CD treated because of ePOR and from whom baseline and follow-up FC measurements as well as an ileocolonoscopic assessment were available. Primary endpoint was endoscopic improvement (decrease in the Rutgeerts' endoscopic score [RES]).

Twenty-two patients with ePOR in whom treatment escalation was started were included. ePOR was treated with anti-TNF in 13 patients (59%), thiopurines in 4 (15%), ustekinumab in 3 (13%) and vedolizumab in 2 (10%). After a median clinical follow-up of 23 months, endoscopic improvement was observed in 68% (n=15). At baseline, 14 patients (64%) had FC levels >200μg/g; endoscopic improvement was observed in 11 (73%) of these and 7 (65%) reduced FC values <200μg/g. All patients with persistence of mucosal lesions remained with FC values >200μg/g. FC levels <250μg/g immediately before endoscopic assessment showed 70% sensitivity and 100% specificity (when baseline FC >200μg/g) for the prediction of endoscopic improvement.

Monitoring FC after treatment escalation for ePOR may be useful for the non-invasive monitoring of endoscopic response.