Digestive Diseases and Sciences

, Volume 63, Issue 5, pp 1294–1301 | Cite as

Fecal Calprotectin in Assessing Endoscopic and Histological Remission in Patients with Ulcerative Colitis

  • Wing Yan Mak
  • Anthony Buisson
  • Michael J. AndersenJr
  • Donald Lei
  • Joel Pekow
  • Russell D. Cohen
  • Stacy A. Kahn
  • Bruno Pereira
  • David T. Rubin
Original Article
  • 173 Downloads

Abstract

Background

Persistent active endoscopic and histological inflammation is associated with poorer outcomes in ulcerative colitis (UC). Fecal calprotectin is a surrogate marker of endoscopic and histological remission.

Aims

To confirm the correlation between fecal calprotectin and endoscopic or histological disease activity and to define the optimal cutoff value to detect endoscopic and histological remission.

Methods

From a prospectively maintained database, we analyzed 61 UC patients who had fecal calprotectin measurement and endoscopy performed within 1 month. Endoscopic activity was graded using the Mayo endoscopic subscore (MES). Histological remission was defined as normal histology or quiescent histological activity.

Results

Eighteen patients (29.5%) and five patients (8.1%) had endoscopic remission defined as MES ≤ 1 or MES = 0, respectively. We observed a significantly lower median level of fecal calprotectin in patients with endoscopic remission than those with endoscopic activity for both definition of endoscopic remission, i.e., MES ≤ 1 (158 vs 490 µg/g, p = 0.0005) or MES = 0 (94 vs 414 µg/g, p = 0.013). Seven patients (11.5%) were in histological remission. They had a lower median level of fecal calprotectin than those with active histological inflammation (107 vs 416 µg/g, p = 0.016). Using a ROC curve, fecal calprotectin < 250 µg/g predicted endoscopic remission (MES ≤ 1) with a sensitivity of 67% and specificity of 77%, while fecal calprotectin < 200 µg/g predicted histological remission with a sensitivity of 71% and specificity of 76%.

Conclusion

Fecal calprotectin level correlated with both endoscopic activity and histological activity and is a reliable biomarker in assessing mucosal healing in UC.

Keywords

Ulcerative colitis Fecal calprotectin Mucosal healing Endoscopic remission Histological remission 

Notes

Author’s contribution

WY Mak helped in substantial contributions to acquisition of data, and analysis of data; co-drafting the article; final approval of the version to be published. A Buisson contributed to substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; co-drafting the article; final approval of the version to be published. MJ Andersen Jr, D Lei, SA Kahn, RD Cohen and J Pekow were involved in substantial contributions to acquisition of data, and analysis of data; revising the article critically for important intellectual content; final approval of the version to be published. B Pereira was involved in substantial contributions to interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published (statistical analysis). DT Rubin contributed to substantial contributions to conception and design, analysis and interpretation of data; final approval of the version to be published.

Compliance with ethical standards

Conflicts of interest

DTR declares consultant fees for Abbvie, Abgenomics, Allergan, Inc., Amgen, Celgene Corporation, Forward Pharma, Genentech/Roche, Janssen Pharmaceuticals, Merck & Co., Inc., Miraca Life Sciences, Napo Pharmaceuticals, Pfizer, Salix Pharmaceuticals, Inc., Samsung Bioepis, Sandoz Pharmaceuticals, Shire, Takeda and grant support from Abbvie, Genentech/Roche, Janssen Pharmaceuticals, Prometheus Laboratories, Shire, Takeda and UCB Pharma. AB declares lecture fees for MSD, Abbvie, Ferring, Takeda, Vifor Pharma, Hospira and consulting fees for Abbvie, Takeda and Hospira. The other authors declare no conflict of interest related to this work.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Wing Yan Mak
    • 1
    • 2
  • Anthony Buisson
    • 1
    • 3
    • 4
  • Michael J. AndersenJr
    • 1
  • Donald Lei
    • 1
  • Joel Pekow
    • 1
  • Russell D. Cohen
    • 1
  • Stacy A. Kahn
    • 1
  • Bruno Pereira
    • 5
  • David T. Rubin
    • 1
  1. 1.Inflammatory Bowel Disease CenterUniversity of Chicago MedicineChicagoUSA
  2. 2.Department of MedicineQueen Elizabeth HospitalYau Ma TeiHong Kong
  3. 3.Inserm, CHU Clermont-Ferrand, 3iHP, Service d’Hépato-Gastro EntérologieUniversité Clermont AuvergneClermont-FerrandFrance
  4. 4.3iHP, Inserm U1071, M2iSH, USC-INRA 2018Université Clermont AuvergneClermont-FerrandFrance
  5. 5.CHU Clermont-Ferrand, DRCI, Unité de BiostatistiquesUniversité Clermont AuvergneClermont-FerrandFrance

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