Background: The clinical utility of non-invasive markers in the diagnosis and monitoring of ulcerative colitis (UC) has been intensively studied. The aim of our study was to evaluate the value of fecal calprotectin (FC) in differentiating between UC and irritable bowel syndrome (IBS), and in estimating inflammatory activity in UC.
Method: A total number of 140 patients were included in the study. All patients underwent ileocolonoscopy with biopsies, quantitative determination of FC, and blood tests (white blood cell count, CRP, ESR). The severity of UC was assessed by using the Ulcerative Colitis Disease Activity Index (UCDAI) and Mayo endoscopic score.
Results: In patients with active UC the mean values of FC were 373.8 +/- 146.3 μg/g, significantly higher than those in the inactive UC (mean values 36.04 +/- 13.25 μg/g), and in IBS (42.9 +/- 16.00 μg/g). In univariate regression analysis, elevated FC levels strongly correlated with pancolitis (p=0.0001), UCDAI and Mayo scores (p=0.0001), and elevated CRP levels. In multivariate regression model, FC was positively associated with severe pancolitis, and elevated CRP. The optimal cutoff value of FC for the prediction of severe pancolitis (Mayo score˃ 3) was 540 μg/g. We obtained 71.4% sensitivity (CI95%: 41.95-91.6) and 96.1% specificity (CI95%: 89.2 -99.2) of FC in assessing the severity of inflammation in UC patients.
Conclusion: FC is a promising marker that can be used in clinical practice to select patients with organic intestinal disorders, compared with those with functional disorders. It also correlates very well with the extent of lesions and the severity of clinical symptoms in UC, with increased sensitivity and specificity.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Kousaku K, Shunji I, Takafumi Y, Nobuhiko F, Naoki O, Hideaki K, et al. Fecal calprotectin level correlated with both endoscopic severity and disease extent in ulcerative colitis. BMC Gastroenterology. 2016 Apr; 16:47. DOI: 10.1186/s12876-016-0462-z
2. Meucci G, Fasoli R, Saibeni S, Valpiani D, Gullotta R, Colombo E, et al. IG-IBD. Prognostic significance of endoscopic remission in patients with active ulcerative colitis treated with oral and topical mesalazine: a prospective, multicenter study. Inflamm Bowel Dis. 2012 Jun;18(6):1006-10. doi: 10.1002/ibd.21838. Epub 2011 Aug 9. DOI: 10.1002/ibd.21838
4. Xiang JY, Ouyang Q, Li GD, Xiao NP. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis. World J Gastroenterol. 2008 Jan;14(1): 53-7. DOI: 10.3748/wjg.14.53
5. Assadsangabi A, Lobo AJ. Diagnosing and managing inflammatory bowel disease. Practitioner. 2013 Jul-Aug;257(1763):13-8.
6. Daperno M, Castiglione F, de Ridder L, Dotan I, Färkkilä M, Florholmen J, et al. Scientific Committee of the European Crohn’s and Colitis Organization. Results of the 2nd part Scientific Workshop of the ECCO. II: Measures and markers of prediction to achieve, detect, and monitor intestinal healing in inflammatory bowel disease. J Crohns Colitis. 2011 Oct;5(5):484-98. DOI: 10.1016/j.crohns.2011.07.003
7. Zaharie R, Tantau A, Zaharie F, Tantau M, Gheorghe L, Gheorghe C, et al. Diagnostic delay in roumanian patients with inflammatory bowel disease: risk factors and impact on the disease course and need for surgery. J Crohns Colitis. 2016 Mar;10(3):306-14. DOI: 10.1093/ecco-jcc/jjv215
8. D’Angelo F, Felley Christian, Frossard JL. Calprotectin in daily practice: where do we stand in 2017. Digestion. 2017;95(4):293-301. DOI: 10.1159/000476062
9. Menees SB, Powell C, Kurlander J, Goel A, Chey WD. A Meta-Analysis of the Utility of C-Reactive Protein, Erythrocyte Sedimentation Rate, Fecal Calprotectin, and Fecal Lactoferrin to Exclude Inflammatory Bowel Disease in Adults With IBS. Am J Gastroenterol. 2015 Mar;110(3):444-54. DOI: 10.1038/ajg.2015.6
11. Tibble JA, Sigthorsson G, Foster R, Forgacs I, Bjarnason I. Use of surrogate markers of inflammation and ROMA criteria to distinguish organic from non-organic intestinal disease. Gastroenterology. 2002 Aug;123(2):450-60. DOI: 10.1053/gast.2002.34755
12. Kotze LM, Nisihara RM, Marion SB, Cavassani MF, Kotze PG. Fecal calprotectin: levels for the ethiological diagnosis in Brazilian patients with gastrointestinal symptoms. Arq Gastroenterol. 2015 Jan-Mar;52(1):50-4. DOI: 10.1590/S0004-28032015000100011
13. Elsaadany HM, Almaghraby MF, Edrees AA, Elsherbiny YM, Kumaet RK. Utility of fecal calprotectin as a discriminative biomarker between ulcerative colitis and irritable bowel syndrome and its ability to be used for the assessment of the remission stage of ulcerative colitis. Egypt J Intern Med. 2016 May; 28:21–27. DOI: 10.4103/1110-7782.182956
14. Nouh MAE, Ali AAE, El Halim EFA, Mohamed HI, El Ghany AMA, Badawy AM. Calprotectin as a fecal marker for diagnosis and follow-up in patients with ulcerative colitis. Menoufia Med J. 2014 May; 27:35–43. DOI: 10.4103/1110-2098.132726
15. Vieira A, Fang CB, Rolim EG, Klug WA, Steinwurz F, Rossini LG, et al. Inflammatory bowel disease activity assessed by fecal calprotectin and lactoferrin: correlation with laboratory parameters, clinical, endoscopic and histological indexes. BMC Res Notes. 2009 Oct 29;2:221. DOI: 10.1186/1756-0500-2-221
16. von Roon AC, Karamountzos L, Purkayastha S, Reese GE, Darzi AW, Teare JP, et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol. 2007 Apr;102(4):80. DOI: 10.1111/j.1572-0241.2007.01126.x
17. van Rheenen PF, E Van de Vijver, V Fidler. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010 Jul;341:c3369. DOI: 10.1136/bmj.c3369
18. Moniuszko A, Głuszek S, Rydzewska G. Rapid fecal calprotectin test for prediction of mucosal inflammation in ulcerative colitis and Crohn disease: a prospective cohort study. Pol Arch Intern Med. 2017 May;127(5):312-318.
19. Ricanek P, Brackmann S, Perminow G, Lyckander LG, Sponheim J, Holme O, et al. Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers. Scand J Gastroenterol. 2011 Sep;46(9):1081-91. DOI: 10.3109/00365521.2011.584897
20. Lobatón T, Bessissow T, De Hertogh G, Lemmens B, Maedler C, Van Assche G, et al. The Modified Mayo Endoscopic Score (MMES): A New Index for the Assessment of Extension and Severity of Endoscopic Activity in Ulcerative Colitis Patients. J Crohns Colitis. 2015 Oct;9(10):846-52. DOI: 10.1093/ecco-jcc/jjv111
21. Sandborn WJ, van Assche G, Reinisch W, Colombel JF, D’Haens G, Wolf DC, et al. Adalimumab induces and maintains clinical remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2012 Feb;142(2):257-65.e1-3. doi: 10.1053/j.gastro. 2011. 10.032. Epub 2011 Nov 4.
22. Schoepfer AM, Beglinger C, Straumann A, Trummler M, Renzulli P, Seibold F. Ulcerative colitis: correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, C-reactive protein, and blood leukocytes. Inflamm Bowel Dis. 2009 Dec;15(12):1851-8. DOI: 10.1002/ibd.20986
23. Schoepfer AM, Beglinger C, Straumann A, Safroneeva E, Romero Y, Armstrong D, et al. Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, C-reactive protein, platelets, hemoglobin, and blood leukocytes. Inflamm Bowel Dis. 2013 Feb;19(2):332-41. DOI: 10.1097/MIB.0b013e3182810066
24. D’Haens G, Ferrante M, Vermeire S, Baert F, Noman M, Moortgat L, et al. Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflamm Bowel Dis. 2012 Dec;18(12):2218-24. DOI: 10.1002/ibd.22917
25. National Institute for Health and Care Excellence. Fecal calprotectin diagnostic tests for inflammatory diseases of the bowel. Diagnostics guidance. 2013 Oct:1-56.