Fecal Calprotectin in Assessing Endoscopic and Histological Remission in Patients with Ulcerative Colitis
- 173 Downloads
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.
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.
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.
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%.
Fecal calprotectin level correlated with both endoscopic activity and histological activity and is a reliable biomarker in assessing mucosal healing in UC.
KeywordsUlcerative colitis Fecal calprotectin Mucosal healing Endoscopic remission Histological remission
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.
- 9.Meucci G, Fasoli R, Saibeni S, et al. 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;18:1006–1010. https://doi.org/10.1002/ibd.21838.CrossRefPubMedGoogle Scholar
- 12.Nakarai A, Kato J, Hiraoka S, et al. Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count. World J Gastroenterol. 2014;20:18367–18374. https://doi.org/10.3748/wjg.v20.i48.18367.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Barreiro-de Acosta M, Vallejo N, de la Iglesia D, et al. Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing (Mayo 0 vs 1): a longitudinal cohort study. J Crohns Colitis. 2016;10:13–19. https://doi.org/10.1093/ecco-jcc/jjv158.CrossRefPubMedGoogle Scholar
- 21.Christensen B, Hanauer SB, Erlich J, et al. Histologic normalization occurs in ulcerative colitis and is associated with improved clinical outcomes. Clin Gastroenterol Hepatol. Published Online First: 02/23/2017. https://doi.org/10.1016/j.cgh.2017.02.016.
- 24.Nancey S, Boschetti G, Moussata D, et al. Neopterin is a novel reliable fecal marker as accurate as calprotectin for predicting endoscopic disease activity in patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2013;19:1043–1052. https://doi.org/10.1097/MIB.0b013e3182807577.CrossRefPubMedGoogle Scholar
- 25.Schoepfer AM, Beglinger C, Straumann A, et al. Ulcerative colitis: correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, C-reactive protein, and blood leukocytes. Inflamm Bowel Dis. 2009;15:1851–1858. https://doi.org/10.1002/ibd.20986.CrossRefPubMedGoogle Scholar
- 26.Schoepfer AM, Beglinger C, Straumann A, 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;19:332–341. https://doi.org/10.1097/MIB.0b013e3182810066.CrossRefPubMedGoogle Scholar
- 27.Buisson A, Vazeille E, Minet-Quinard R, et al. Faecal chitinase 3-like 1 is a reliable marker as accurate as faecal calprotectin in detecting endoscopic activity in adult patients with inflammatory bowel diseases. Aliment Pharmacol Ther. 2016;43:1069–1079. https://doi.org/10.1111/apt.13585.CrossRefPubMedGoogle Scholar
- 28.Buisson A, Vazeille E, Minet-Quinard R, et al. Fecal Matrix Metalloprotease-9 and Lipocalin-2 as biomarkers in detecting endoscopic activity in patients with inflammatory bowel diseases. J Clin Gastroenterol. Published Online First: 7/18/2017. https://doi.org/10.1097/mcg.0000000000000837.
- 29.Magro F, Lopes S, Coelho R, et al. Accuracy of faecal calprotectin and neutrophil gelatinase B-associated lipocalin in evaluating subclinical inflammation in UlceRaTIVE Colitis—the ACERTIVE study. J Crohns Colitis. 2017;11:435–444. https://doi.org/10.1093/ecco-jcc/jjw170.CrossRefPubMedGoogle Scholar
- 32.Guardiola J, Lobatón T, Rodríguez-Alonso L, et al. Fecal level of calprotectin identifies histologic inflammation in patients with ulcerative colitis in clinical and endoscopic remission. Clin Gastroenterol Hepatol. 2014;12:1865–1870. https://doi.org/10.1016/j.cgh.2014.06.020.CrossRefPubMedGoogle Scholar