Correlation between Rutgeerts Score, Imaging, and Fecal Calprotectin in Patients with Crohn's Disease

Aims Crohn’s disease (CD) is a chronic inflammatory bowel disease often associated with recurrence after ileocolonic resection. Assessing this postoperative recurrence is crucial for adapting therapeutic follow-up and preventing complications. Among the follow-up tools, the Rutgeerts score is commonly used to evaluate endoscopic outcomes and predict recurrence risk. Additionally, fecal calprotectin, a non-invasive marker of intestinal inflammation, and imaging can provide complementary information on disease activity.This study aims to analyze the correlation between the Rutgeerts score, fecal calprotectin, and imaging results in CD patients who have undergone ileocolonic resection.

Methods This retrospective, single-center study was conducted in a university department of Hepato-Gastroenterology and Proctology. Out of 1,195 CD patients, 26 who had undergone ileocolonic resection were included in the study. These patients were selected based on the availability of fecal calprotectin data, follow-up colonoscopy, and postoperative imaging.

Results The study included 26 Crohn’s disease patients with a median age of 43 years and a sex ratio of 0.86 men per woman. Disease localization (Montreal classification) was 15% ileal (L1), 23% colonic (L2), and 62% ileocolonic (L3). Phenotypes were distributed as 19% non-stricturing/non-penetrating (B1), 50% stricturing (B2), and 31% fistulizing (B3). The interval between fecal calprotectin measurement, endoscopy, and imaging ranged from 15 days to one month.The study found a moderate correlation (0.595) between fecal calprotectin levels and the Rutgeerts score, suggesting that higher calprotectin is linked to a greater risk of endoscopic recurrence. The Rutgeerts score and cross-sectional imaging showed a moderate correlation (0.512), indicating imaging’s usefulness but lesser accuracy than endoscopy for assessing inflammation. A low correlation (0.064) was observed between fecal calprotectin and imaging, suggesting potential discordance between calprotectin levels and imaging-detected inflammation, which questions if imaging findings (e.g., intestinal wall thickening) should always prompt additional endoscopic evaluation.

Conclusions These findings support the use of a combined approach, with endoscopy as the primary tool for detecting postoperative recurrence and fecal calprotectin as a valuable, non-invasive marker for long-term monitoring. The moderate correlation between calprotectin and the Rutgeerts score suggests that fecal calprotectin can complement endoscopic follow-up. The low correlation between imaging and calprotectin underscores the need for further studies to refine imaging’s role in monitoring postoperative CD patients.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025