Subscribe to RSS
Can Fecal Calprotectin Reflect Your Colonic Status?Funding None.
Background Organic colonic manifestation may be difficult to be differentiated from functional one. Inflammatory bowel disease (IBD) is a common chronic inflammatory and destructive disease of the bowel wall. Chronic inflammation is associated with ulcerations, strictures, perforations, and it is a risk factor for dysplasia and cancer. To reduce these long-standing complications, IBD patients are in a continuous need for early diagnosis. Markers, such as erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP), fecal calprotectin (FC) have been widely used as noninvasive parameters for IBD monitoring. We aimed, in this current study, to evaluate the value of fecal calprotectin and other noninvasive biomarkers in predicting abnormal histologic findings in patients undergoing colonoscopy.in addition to determine the cutoff value which predict IBD.
Methods The present prospective study included 160 patients with complaint of colicky abdominal pain with frequent diarrhea associated with mucous and infrequent bleeding per rectum for more than 6 months. They presented partial improvement with medication and recurrence once stopping the treatment These patients had been recently diagnosed with IBD at many primary healthcare centers covering the areas of the Kafrelsheikh and Zagazik governorate in the North of Egyptian Nile delta. After complete history, clinical examination, and laboratory investigation, they were referred to the IBD clinic at Kafrelsheikh University Hospital for assessment and ileocolonoscopy with biopsies.
Results There was a wide spectrum of age of the studied patients, with mean age 40.12 ± 7.88 (minimum 18 and maximum 56 years). Regarding gender, males represented 87.5% of the studied patients. Forty percent of the patients with colonic manifestation were smokers, 57% preferred a spicy diet, and the majority had low educational level (77.5%). Forty percent had obvious blood in stool, 55% had occult blood, and raised ESR CRP occurred in 32.5% and 50%, respectively. Fecal calprotectin cutoff was > 159, with sensitivity 92.8% and specificity 97.5%.
Conclusions: Biomarkers (FC, ESR, CRP) can be used as noninvasive parameters for the early diagnosis and prediction of organic colonic disease. Fecal calprotectin in the IBD group revealed significant area under the curve (AUC) values and cutoff > 159, with sensitivity 92.8% and specificity 97.5%.
Keywordscolonic manifestations - ulcerative colitis - fecal calprotectin - primary health care - markers
Ethics & Consents
The present study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice, and applicable regulatory requirements. A written informed consent was obtained from all patients after explanation of the research idea.
All authors contributed equally towards formulating the idea, conception, data collection, statistics, writing, and drafting of the manuscript.
Received: 14 November 2020
Accepted: 15 June 2021
Article published online:
11 February 2022
© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
- 1 El-Saka AM, Zamzam YA, Haydara T, Abd-Elsalam S. Immunohistochemical staining with chemokine panel of non-specific colitis predicts future IBD diagnosis. Cytokine 2020; 127: 154935
- 2 Romberg-Camps MJL, Bol Y, Dagnelie PC. et al. Fatigue and health-related quality of life in inflammatory bowel disease: results from a population-based study in the Netherlands: the IBD-South Limburg cohort. Inflamm Bowel Dis 2010; 16 (12) 2137-2147
- 3 Haapamäki J, Roine RP, Sintonen H, Turunen U, Färkkilä MA, Arkkila PE. Health-related quality of life in inflammatory bowel disease measured with the generic 15D instrument. Qual Life Res 2010; 19 (06) 919-928
- 4 Mahadev S, Young JM, Selby W, Solomon MJ. Quality of life in perianal Crohn's disease: what do patients consider important?. Dis Colon Rectum 2011; 54 (05) 579-585
- 5 Schirbel A, Reichert A, Roll S. et al. Impact of pain on health-related quality of life in patients with inflammatory bowel disease. World J Gastroenterol 2010; 16 (25) 3168-3177
- 6 von Roon AC, Karamountzos L, Purkayastha S. et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol 2007; 102 (04) 803-813
- 7 Foell D, Frosch M, Sorg C, Roth J. Phagocyte-specific calcium-binding S100 proteins as clinical laboratory markers of inflammation. Clin Chim Acta 2004; 344 (1-2): 37-51
- 8 Silverberg MS, Satsangi J, Ahmad T. et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005; 19 Suppl A: 5A-36A
- 9 Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut 2012; 61 (11) 1619-1635
- 10 Kaplan GG, Ng SC. Understanding and Preventing the Global Increase of Inflammatory Bowel Disease. Gastroenterology 2017; 152 (02) 313-321.e2
- 11 Regueiro M, Click B, Holder D, Shrank W, McAnallen S, Szigethy E. Constructing an Inflammatory Bowel Disease Patient-Centered Medical Home. Clin Gastroenterol Hepatol 2017; 15 (08) 1148-1153.e4
- 12 Rubin GP, Hungin AP, Kelly PJ, Ling J. Inflammatory bowel disease: epidemiology and management in an English general practice population. Aliment Pharmacol Ther 2000; 14 (12) 1553-1559
- 13 Cheung WY, Dove J, Lervy B, Russell IT, Williams JG. Shared care in gastroenterology: GPs' views of open access to out-patient follow-up for patients with inflammatory bowel disease. Fam Pract 2002; 19 (01) 53-56
- 14 Bennett AL, Munkholm P, Andrews JM. Tools for primary care management of inflammatory bowel disease: do they exist?. World J Gastroenterol 2015; 21 (15) 4457-4465
- 15 Alharbi R, Almahmudi F, Makhdoom Y, Mosli M. Knowledge and attitudes of primary healthcare physicians toward the diagnosis and management of inflammatory bowel disease following an educational intervention: A comparative analysis. Saudi J Gastroenterol 2019; 25 (05) 277-285
- 16 Arthurs EA, Gholkar B, Burley K, Williams L, Lockett M. The medical management of inflammatory bowel disease in primary care: the north Bristol experience. Gut 2011; 60: A130
- 17 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 (01) 15-22
- 18 Vermeire S, Van Assche G, Rutgeerts P. C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis 2004; 10 (05) 661-665
- 19 Costa F, Mumolo MG, Ceccarelli L. et al. Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn's disease. Gut 2005; 54 (03) 364-368
- 20 Holtman GA, Lisman-van Leeuwen Y, Reitsma JB, Berger MY. Noninvasive Tests for Inflammatory Bowel Disease: A Meta-analysis. Pediatrics 2016;137(01):
- 21 Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys?. Gut 2006; 55 (03) 426-431
- 22 Aomatsu T, Yoden A, Matsumoto K. et al. Fecal calprotectin is a useful marker for disease activity in pediatric patients with inflammatory bowel disease. Dig Dis Sci 2011; 56 (08) 2372-2377
- 23 Kristinsson J, Armbruster CH, Ugstad M. et al. Fecal excretion of calprotectin in colorectal cancer: relationship to tumor characteristics. Scand J Gastroenterol 2001; 36 (02) 202-207
- 24 MH Ahmed, MH Emara, EM Saeed. etal. How Valuable are Noninvasive Tests as? Indicators of IBD Activity and Severity in? the Primary Health Care??. Afro-Egyptian Journal of Infectious and Endemic 2021; 11 (02) 113-119
- 25 Kristensen V, Røseth A, Ahmad T, Skar V, Moum B. Fecal Calprotectin: A Reliable Predictor of Mucosal Healing after Treatment for Active Ulcerative Colitis. Gastroenterol Res Pract 2017; 2017: 2098293