Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2372–2377

Fecal Calprotectin Is a Useful Marker for Disease Activity in Pediatric Patients with Inflammatory Bowel Disease

  • Tomoki Aomatsu
  • Atsushi Yoden
  • Kyoichi Matsumoto
  • Emi Kimura
  • Keisuke Inoue
  • Akira Andoh
  • Hiroshi Tamai
Original Article



Studies evaluating the correlation between endoscopic disease activity and noninvasive markers are scarce in inflammatory bowel disease (IBD).


The aim of this study is to evaluate the accuracy of the fecal calprotectin (FC) assay as a marker of disease activity of IBD, as determined by an extensive endoscopic scoring system.


Thirty-five children and adolescents with IBD [17 with ulcerative colitis (UC) and 18 with Crohn’s disease (CD)] and 28 healthy volunteers were enrolled. FC levels were determined by ELISA. The sum of Matts’ score for UC and the simple endoscopic score for Crohn’s disease (SES-CD) were used. The ileal lesions were evaluated by ultrasonography.


In UC patients, there was a strong correlation between FC levels and the sum of Matts’ score (r = 0.838, p < 0.01). FC levels were significantly elevated in endoscopically active patients (median 1,562.5 μg/g) as compared to patients in endoscopic remission (median 38.9 μg/g) or healthy controls (median 19.9 μg/g). In CD patients, there was a strong correlation between FC levels and the SES-CD score (r = 0.760, p < 0.01). The FC levels were significantly higher in endoscopically active patients (median 2,037.5 μg/g) than in endoscopically inactive patients (median 172.5 μg/g) or healthy controls (median 19.9 μg/g), respectively. The FC levels of patients with ileal wall thickening (median 2,225.0 μg/g) were significantly higher than healthy controls (median 19.9 μg/g) and patients lacking ileal wall thickening (median 17.5 μg/g), respectively.


The FC assay is a useful marker for the detection of mucosal inflammation in pediatric IBD patients.


Fecal calprotectin Inflammatory bowel disease Children Mucosal healing Biomarker 


  1. 1.
    Mizoguchi A, Mizoguchi E. Inflammatory bowel disease, past, present and future: lessons from animal models. J Gastroenterol. 2008;43:1–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Mayer L. Evolving paradigms in the pathogenesis of IBD. J Gastroenterol. 2010;45:9–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Sands BE. Inflammatory bowel disease: past, present, and future. J Gastroenterol. 2007; 42:16–25.Google Scholar
  4. 4.
    Cabrera-Abreu JC, Davies P, Matek Z, Murphy MS. Performance of blood tests in diagnosis of inflammatory bowel disease in a specialist clinic. Arch Dis Child. 2004;89:69–71.PubMedGoogle Scholar
  5. 5.
    Mack DR, Langton C, Markowitz J, et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics. 2007;119:1113–1119.PubMedCrossRefGoogle Scholar
  6. 6.
    Quail MA, Russell RK, Van Limbergen JE, et al. Fecal calprotectin complements routine laboratory investigations in diagnosing childhood inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:756–759.PubMedCrossRefGoogle Scholar
  7. 7.
    Vieira A, Fang CB, Rolim EG, 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;2:221.PubMedCrossRefGoogle Scholar
  8. 8.
    Beattie RM, Walker-Smith JA, Murch SH. Indications for investigation of chronic gastrointestinal symptoms. Arch Dis Child. 1995;73:354–355.PubMedCrossRefGoogle Scholar
  9. 9.
    Gisbert JP, McNicholl AG. Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease. Dig Liver Dis. 2009;41:56–66.PubMedCrossRefGoogle Scholar
  10. 10.
    Desai D, Faubion WA, Sandborn WJ. Review article: biological activity markers in inflammatory bowel disease. Aliment Pharmacol Ther. 2007;25:247–255.PubMedCrossRefGoogle Scholar
  11. 11.
    Limburg PJ, Ahlquist DA, Sandborn WJ, et al. Fecal calprotectin levels predict colorectal inflammation among patients with chronic diarrhea referred for colonoscopy. Am J Gastroenterol. 2000;95:2831–2837.PubMedCrossRefGoogle Scholar
  12. 12.
    Dale I, Fagerhol MK, Naesgaard I. Purification and partial characterization of a highly immunogenic human leukocyte protein, the L1 antigen. Eur J Biochem. 1983;134:1–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Gaya DR, Lyon TD, Duncan A, et al. Faecal calprotectin in the assessment of Crohn’s disease activity. QJM. 2005;98:435–441.PubMedCrossRefGoogle Scholar
  14. 14.
    Ashorn S, Honkanen T, Kolho KL, et al. Fecal calprotectin levels and serological responses to microbial antigens among children and adolescents with inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:199–205.PubMedCrossRefGoogle Scholar
  15. 15.
    Sipponen T, Savilahti E, Karkkainen P, et al. Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for Crohn’s disease. Inflamm Bowel Dis. 2008;14:1392–1398.PubMedCrossRefGoogle Scholar
  16. 16.
    Sipponen T, Karkkainen P, Savilahti E, et al. Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn’s disease and histological findings. Aliment Pharmacol Ther. 2008;28:1221–1229.PubMedCrossRefGoogle Scholar
  17. 17.
    Joishy M, Davies I, Ahmed M, et al. Fecal calprotectin and lactoferrin as noninvasive markers of pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009;48:48–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Diamanti A, Panetta F, Basso MS, Forgione A, Colistro F, Bracci F, Papadatou B, Francalanci P, Torroni F, Knafelz D et al. Diagnostic work-up of inflammatory bowel disease in children: the role of calprotectin assay. Inflamm Bowel Dis. 2010;16:1926–1930.PubMedCrossRefGoogle Scholar
  19. 19.
    Kallel L, Ayadi I, Matri S, et al. Fecal calprotectin is a predictive marker of relapse in Crohn’s disease involving the colon: a prospective study. Eur J Gastroenterol Hepatol. 2010;22:340–345.PubMedCrossRefGoogle Scholar
  20. 20.
    Ho GT, Lee HM, Brydon G, et al. Fecal calprotectin predicts the clinical course of acute severe ulcerative colitis. Am J Gastroenterol. 2009;104:673–678.PubMedCrossRefGoogle Scholar
  21. 21.
    Fagerberg UL, Loof L, Lindholm J, Hansson LO, Finkel Y. Fecal calprotectin: a quantitative marker of colonic inflammation in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2007;45:414–420.PubMedCrossRefGoogle Scholar
  22. 22.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–753.PubMedCrossRefGoogle Scholar
  23. 23.
    Turner D, Otley AR, Mack D, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007;133:423–432.PubMedCrossRefGoogle Scholar
  24. 24.
    Hyams JS, Ferry GD, Mandel FS, et al. Development and validation of a pediatric Crohn’s disease activity index. J Pediatr Gastroenterol Nutr. 1991;12:439–447.PubMedGoogle Scholar
  25. 25.
    Matts SG. The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med. 1961;30:393–407.PubMedGoogle Scholar
  26. 26.
    Osada T, Ohkusa T, Yokoyama T, Shibuya T, Sakamoto N, Beppu K, Nagahara A, Otaka M, Ogihara T, Watanabe S. Comparison of several activity indices for the evaluation of endoscopic activity in UC: inter- and intraobserver consistency. Inflamm Bowel Dis. 2010;16:192–197.PubMedGoogle Scholar
  27. 27.
    Daperno M, D’Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc. 2004;60:505–512.PubMedCrossRefGoogle Scholar
  28. 28.
    Minderhoud IM, Samsom M, Oldenburg B. What predicts mucosal inflammation in Crohn’s disease patients? Inflamm Bowel Dis. 2007;13:1567–1572.PubMedCrossRefGoogle Scholar
  29. 29.
    Puylaert JB. Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am. 2003; 41:1227–1242, vii.Google Scholar
  30. 30.
    Sturm EJ, Cobben LP, Meijssen MA, van der Werf SD, Puylaert JB. Detection of ileocecal Crohn’s disease using ultrasound as the primary imaging modality. Eur Radiol. 2004;14:778–782.PubMedCrossRefGoogle Scholar
  31. 31.
    Gisbert JP, McNicholl AG, Gomollon F. Questions and answers on the role of fecal lactoferrin as a biological marker in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:1746–1754.PubMedCrossRefGoogle Scholar
  32. 32.
    Kaiser T, Langhorst J, Wittkowski H, et al. Faecal S100A12 as a non-invasive marker distinguishing inflammatory bowel disease from irritable bowel syndrome. Gut. 2007;56:1706–1713.PubMedCrossRefGoogle Scholar
  33. 33.
    Bremner A, Roked S, Robinson R, Phillips I, Beattie M. Faecal calprotectin in children with chronic gastrointestinal symptoms. Acta Paediatr. 2005;94:1855–1858.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Tomoki Aomatsu
    • 1
  • Atsushi Yoden
    • 1
  • Kyoichi Matsumoto
    • 2
  • Emi Kimura
    • 2
  • Keisuke Inoue
    • 1
  • Akira Andoh
    • 3
  • Hiroshi Tamai
    • 1
  1. 1.Department of PediatricsOsaka Medical CollegeTakatsukiJapan
  2. 2.Mikuri Immunological Lab. CoYaoJapan
  3. 3.Division of Mucosal Immunology, Graduate School of MedicineShiga University of Medical ScienceOtsuJapan

Personalised recommendations