Skip to main content

Advertisement

SpringerLink
Log in

Accuracy of Rapid Fecal Calprotectin Test in Monitoring Inflammatory Bowel Diseases Under Treatment with TNFα Antagonists

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Anti-TNFα antibodies are effective in treating inflammatory bowel diseases (IBDs) unresponsive to the standard treatments. Information about the role of rapid fecal calprotectin (FC) in monitoring ambulatory IBD patients under treatment with anti-TNFα is lacking. Our aim was to assess the accuracy of rapid FC in monitoring those patients.

Methods

Seventy-two patients (38 males, 34 females, mean age 42.5 years, range 23–57 years), affected by ulcerative colitis (UC) (20 patients) or by Crohn’s disease (CD) (52 patients) were treated with anti-TNFα antibodies. FC was assessed by a rapid semiquantitative test.

Results

With respect to the absence of clinical remission, FC test showed sensitivity of 71.8 %, specificity of 65.2 %, PPV of 41.8 %, and NPV of 86.9 %. In UC patients, FC test showed a sensitivity of 66.7 %, a specificity of 56.1 %, a PPV of 18.2 %, and a NPV of 92.0 %. In CD patients, FC test showed sensitivity of 70.6 %, specificity of 65.2 %, PPV of 50.0 %, and NPV of 81.8 %. With respect to the presence of endoscopic lesions, FC test showed sensitivity of 73.5 %, specificity of 96.0 %, PPV of 96.2 %, and NPV of 72.7 %. In UC patients, FC test showed sensitivity of 47.2 %, specificity of 84.6 %, PPV of 89.5 %, and NPV of 36.7 %. In CD patients, FC test showed sensitivity of 90.1 %, specificity of 79.7 %, PPV of 71.9 %, and NPV of 93.3 %.

Conclusions

Diagnostic accuracy of rapid FC seems better in predicting persistence of endoscopic lesions than clinical remission in IBD patients under treatment with anti-TNFα.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lichtenstein GR, Abreu MT, Cohen R, Tremaine W, American Gastroenterological Association. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006;130:940–987.

    Article  CAS  PubMed  Google Scholar 

  2. Costa F, Mumolo MG, Bellini M, et al. Role of faecal calprotectin as non-invasive marker of intestinal inflammation. Dig Liver Dis. 2003;35:642–647.

    Article  CAS  PubMed  Google Scholar 

  3. Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I. Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology. 2000;119:15–22.

    Article  CAS  PubMed  Google Scholar 

  4. Roseth AG, Aadland E, Jahnsen J, Raknerud N. Assessment of disease activity in ulcerative colitis by faecal calprotectin, a novel granulocyte marker protein. Digestion. 1997;58:176–180.

    Article  CAS  PubMed  Google Scholar 

  5. Roseth AG, Fagerhol M, Aadland E, Schjonsby H. Assessment of neutrophil dominating protein calprotectin in feces. A methodological study. Scand J Gastroenterol. 1992;27:793–798.

    Article  CAS  PubMed  Google Scholar 

  6. Teahon K, Roseth AG, Foster R, Bjarnason I. Fecal calprotectin: a simple sensitive quantitative measure of intestinal inflammation in man. Gastroenterology. 1997;112:A1103.

    Article  Google Scholar 

  7. Costa F, Mumolo MG, Ceccarelli L, et al. Calprotectin is stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease. Gut. 2005;54:364–368.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Molander P, Af Björkesten CG, Mustonen H, et al. Fecal calprotectin concentration predicts outcome in inflammatory bowel disease after induction therapy with TNFα blocking agents. Inflamm Bowel Dis. 2012;18:2011–2017.

    Article  PubMed  Google Scholar 

  9. Wassell J, Wallage M, Brewer E. Evaluation of the quantum Blue® rapid test for faecal calprotectin. Ann Clin Biochem. 2012;49:55–58.

    Article  CAS  PubMed  Google Scholar 

  10. Lobatón T, Rodríguez-Moranta F, Lopez A, Sánchez E, Rodríguez-Alonso L, Guardiola J. A new rapid quantitative test for fecal calprotectin predicts endoscopic activity in ulcerative colitis. Inflamm Bowel Dis. 2013;19:1034–1042.

    Article  PubMed  Google Scholar 

  11. Lobatón T, López-García A, Rodríguez-Moranta F, Ruiz A, Rodríguez L, Guardiola J. A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn’s disease. J Crohns Colitis. 2013;7:e641–e651.

    Article  PubMed  Google Scholar 

  12. Inoue K, Aomatsu T, Yoden A, Okuhira T, Kaji E, Tamai H. Usefulness of a novel and rapid assay system for fecal calprotectin in pediatric patients with inflammatory bowel diseases. J Gastroenterol Hepatol. 2014;29:1406–1412.

    Article  CAS  PubMed  Google Scholar 

  13. Vestergaard TA, Nielsen SL, Dahlerup JF, Hornung N. Fecal calprotectin: assessment of a rapid test. Scand J Clin Lab Invest. 2008;68:343–347.

    Article  CAS  PubMed  Google Scholar 

  14. Damms A, Bischoff SC. Validation and clinical significance of a new calprotectin rapid test for the diagnosis of gastrointestinal diseases. Int J Colorectal Dis. 2008;23:985–992.

    Article  CAS  PubMed  Google Scholar 

  15. Tursi A, Elisei W, Giorgetti G, Picchio M, Brandimarte G. Rapid fecal calprotectin correlates with clinical and endoscopic severity of inflammatory bowel diseases. Scand J Gastroenterol. 2013;48:1359–1360.

    Article  PubMed  Google Scholar 

  16. Rizzello F, Gionchetti P, D’Arienzo A, et al. Oral beclometasone dipropionate in the treatment of active ulcerative colitis: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2002;16:1109–1116.

    Article  CAS  PubMed  Google Scholar 

  17. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis: a randomised study. N Engl J Med. 1987;317:1625–1629.

    Article  CAS  PubMed  Google Scholar 

  18. Panaccione R, Ghosh S, Middleton S, et al. Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology. 2014;146:392–400.e3.

    Article  PubMed  Google Scholar 

  19. Best WR. Predicting the Crohn’s disease activity index from the Harvey-Bradshaw Index. Inflamm Bowel Dis. 2006;12:304–310.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Moskovitz DN, Daperno M, Van Assche G. Defining and validating cut-offs for the Simple Endocopic Score for Crohn’s Disease. Gastroenterology. 2007;132:S1097.

    Google Scholar 

  22. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–1395.

    Article  CAS  PubMed  Google Scholar 

  23. Parakkal D, Sifuentes H, Semer R, Ehrenpreis ED. Hepatosplenic T-cell lymphoma in patients receiving TNF-α inhibitor therapy: expanding the groups at risk. Eur J Gastroenterol Hepatol. 2011;23:1150–1156.

    Article  CAS  PubMed  Google Scholar 

  24. Tursi A. Letter: should immunosuppressive therapy be started with adalimumab in Crohn’s disease? Aliment Pharmacol Ther. 2013;37:752.

    Article  CAS  PubMed  Google Scholar 

  25. Osterman MT, Sandborn WJ, Colombel JF, et al. Increased risk of malignancy with adalimumab combination therapy, compared with monotherapy, for Crohn’s disease. Gastroenterology. 2014;146:941-9.e2.

    Article  Google Scholar 

  26. Gisbert JP, Bermejo F, Pérez-Calle JL, et al. Faecal calprotectin and lactoferrin or the prediction of inflammatory bowel disease relapse. Inflamm Bowel Dis. 2009;15:1190–1198.

    Article  PubMed  Google Scholar 

  27. Kallel L, Ayadi I, Matri S, et al. Faecal calprotectin is a predictive marker of relapse in Crohn’s disease involving the colon: a prospec-tive study. Eur J Gastroenterol Hepatol. 2010;22:340–345.

    Article  CAS  PubMed  Google Scholar 

  28. Guidi L, Marzo M, Andrisani G, Felice C, Pugliese D, Mocci G, Nardone O, De Vitis I, Papa A, Rapaccini G, Forni F, Armuzzi A. Fecal calprotectin assay after induction with anti-tumour necrosis factor α agents in inflammatory bowel disease: prediction of clinical response and mucosal healing at one year. Dig Liver Dis 2014. (Epub ahead of print). doi:10.1016/j.dld.2014.07.013

  29. Molander P, af Björkesten CG, Mustonen H, et al. Faecal calprotectin concentration predicts outcome in inflammatory bowel disease after induction therapy ith TNFα blocking agents. Inflamm Bowel Dis. 2012;18:2011–2017.

    Article  PubMed  Google Scholar 

  30. Mao R, Xiao YL, Gao X, et al. Faecal calprotectin in predicting relapse of inflammatory bowel diseases: a meta-analysis of prospective studies. Inflamm Bowel Dis. 2012;18:1894–1899.

    Article  PubMed  Google Scholar 

  31. Schoepfer AM, Beglinger C, Straumann A, et al. Faecal 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.

    Article  PubMed  Google Scholar 

  32. af Björkesten CG, Nieminen U, Turunen U, Arkkila P, Sipponen T, Färkkilä M. Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn’s disease. Scand J Gastroenterol. 2012;47:528–537.

    Article  PubMed  Google Scholar 

  33. Sipponen T, Kärkkäinen P, Savilahti E, et al. Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn’s disease and histological findings. Alim Pharmacol Ther. 2008;28:1221–1229.

    Article  CAS  Google Scholar 

  34. Sipponen T, Björkesten CG, Färkkilä M, Nuutinen H, Savilahti E, Kolho KL. Faecal calprotectin and lactoferrin are reliable surrogate markers of endoscopic response during Crohn’s disease treatment. Scand J Gastroenterol. 2010;45:325–331.

    Article  CAS  PubMed  Google Scholar 

  35. Schoepfer AM, Beglinger C, Straumann A, et al. Faecal calprotectin correlates ore closely with the Simple Endoscopic Score for Crohn’s disease (SES-CD) than CRP, blood leukocytes, and the CDAI. Am J Gastroenterol. 2010;105:162–169.

    Article  CAS  PubMed  Google Scholar 

  36. Sipponen T, Savilahti E, Kolho KL, Nuutinen H, Turunen U, Färkkilä M. Crohn’s disease activity assessed by aecal calprotectin and lactoferrin: correlation with Crohn’s disease activity index and endoscopic findings. Inflamm Bowel Dis. 2008;14:40–46.

    Article  PubMed  Google Scholar 

  37. D’Haens G, Ferrante M, Vermeire S, et al. Faecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:2218–2224.

    Article  PubMed  Google Scholar 

  38. De Vos M, Dewit O, D’Haens G, et al. Fast and sharp decrease in calprotectin predicts remission by infliximab in anti-TNF naïve patients with ulcerative colitis. J Crohn Colitis. 2012;6:557–562.

    Article  CAS  Google Scholar 

  39. Jauregui-Amezaga A, López-Cerón M, Aceituno M, et al. Accuracy of advanced endoscopy and fecal calprotectin for prediction of relapse in ulcerative colitis: a prospective study. Inflamm Bowel Dis. 2014;20:1187–1193.

    Article  PubMed  Google Scholar 

  40. Mooiweer E, Fidder HH, Siersema PD, Laheij RJ, Oldenburg B. Fecal hemoglobin and calprotectin are equally effective in identifying patients with inflammatory bowel disease with active endoscopic inflammation. Inflamm Bowel Dis. 2014;20:307–314.

    Article  PubMed  Google Scholar 

  41. Lin JF, Chen JM, Zuo JH, et al. Meta-analysis: fecal calprotectin for assessment of inflammatory bowel disease activity. Inflamm Bowel Dis. 2014;20:1407–1415.

    Article  PubMed  Google Scholar 

  42. Rosenberg L, Lawlor GO, Zenlea T, et al. Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis. 2013;19:779–784.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

  1. Gastroenterology Service, ASL BAT, Via Torino, 49, 76123, Andria, BT, Italy

    Antonio Tursi

  2. Division of Gastroenterology, ASL Roma H, Albano Laziale, Rome, Italy

    Walter Elisei

  3. Division of Surgery, “P. Colombo” Hospital, Velletri, Rome, Italy

    Marcello Picchio

  4. Digestive Endoscopy and Nutrition Unit, “S. Eugenio” Hospital, Rome, Italy

    GianMarco Giorgetti

  5. Division of Gastroenterology, “Cristo Re” Hospital, Rome, Italy

    Giovanni Brandimarte

Authors
  1. Antonio Tursi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Walter Elisei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcello Picchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. GianMarco Giorgetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Brandimarte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Tursi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tursi, A., Elisei, W., Picchio, M. et al. Accuracy of Rapid Fecal Calprotectin Test in Monitoring Inflammatory Bowel Diseases Under Treatment with TNFα Antagonists. Dig Dis Sci 60, 1406–1413 (2015). https://doi.org/10.1007/s10620-014-3459-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3459-x

Keywords

Search

Navigation