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Fecal Calprotectin and the Clinical Activity Index Are Both Useful to Monitor Medical Treatment in Patients with Ulcerative Colitis

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Abstract

Background

Non-invasive monitoring of inflammatory bowel disease is an unmet clinical need as patients in clinical remission may have residual mucosal inflammation preceding clinical relapse.

Aims

We aimed to assess the value of fecal calprotectin and standardized clinical activity scoring to monitor disease activity in ulcerative colitis under medical treatment.

Methods

Forty-one patients with ulcerative colitis were included in a prospective observational study. Medical treatment was guided by clinical judgement of treating physicians. Fecal calprotectin and the clinical activity index (CAI) were measured blinded to treating physicians every 2 months until the end of follow-up. Twenty-six patients received colonoscopy for clinical reason.

Results

As defined by the CAI, patients were in clinical remission (63.4 %), having mild (26.8 %) or moderate (11.2 %) disease activity. Of those in clinical remission (CAI ≤ 4), 86.4 % showed residual endoscopic activity (Mayo Score ≥1). Calprotectin levels were higher in endoscopically active disease (779.0 vs 331.5 μg/g, P = 0.034) and calprotectin testing identified more patients with endoscopic disease activity (86.4 %) than the CAI (45.5 %, P = 0.034). Medical treatment was escalated in 90.2 % during the study. Values of the CAI and calprotectin correlated with therapy escalation (OR 3.94 and 3.22, respectively). Only for calprotectin, changes between two measurements were related to intensified medical treatment (OR 1.39).

Conclusion

Fecal calprotectin was similarly useful to the CAI to monitor disease activity of ulcerative colitis during medical treatment but identified endoscopic disease activity far more reliably. Changes of calprotectin values between measurements might indicate clinical relapse earlier than the CAI.

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Acknowledgments

Viollier AG (Basel, Switzerland) performed all measurements of FC. Researchers were independent of funding. We are indebted to the patients who participated in the study for their most valuable efforts.

Conflict of interest

All authors report no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, University Medical Clinic, Cantonal Hospital, Rheinstrasse 24, 4410, Liestal, Switzerland

    Emanuel Burri

  2. Department of Gastroenterology and Hepatology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Christoph Beglinger & Frank Serge Lehmann

  3. Clinical Trial Unit, University Hospital, Schanzenstrasse 55, 4031, Basel, Switzerland

    Stefanie von Felten

Authors
  1. Emanuel Burri
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  2. Christoph Beglinger
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  3. Stefanie von Felten
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  4. Frank Serge Lehmann
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Corresponding author

Correspondence to Christoph Beglinger.

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Burri, E., Beglinger, C., von Felten, S. et al. Fecal Calprotectin and the Clinical Activity Index Are Both Useful to Monitor Medical Treatment in Patients with Ulcerative Colitis. Dig Dis Sci 60, 485–491 (2015). https://doi.org/10.1007/s10620-014-3383-0

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  • DOI: https://doi.org/10.1007/s10620-014-3383-0

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