Normalization of faecal calprotectin: a predictor of mucosal healing in patients with inflammatory bowel disease.

Aker University Hospital, Oslo, Norway.
Scandinavian Journal of Gastroenterology (Impact Factor: 2.33). 10/2004; 39(10):1017-20. DOI: 10.1080/00365520410007971
Source: PubMed
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    ABSTRACT: Targeted therapy, using biomarkers to assess disease activity in ulcerative colitis (UC), has been proposed. The objective of this study was to evaluate whether pharmacological intervention guided by fecal calprotectin (FC) prolongs remission in patients with UC. A total of 91 adults with UC in remission were randomized to an intervention group or a control group. Analysis of FC was performed monthly, during 18 months. A FC value of 300 µg/g was set as the cut-off for intervention, which was a dose escalation of the oral 5-aminosalicylate (5-ASA) agent. The primary study end-point was the number of patients to have relapsed by month 18. There were relapses in 18 (35.3%) and 20 (50.0%) patients in the intervention and the control groups, respectively (p = 0.23); and 28 (54.9%) patients in the intervention group and 28 (70.0%) patients in the control group had a FC > 300 µg/g, of which 8 (28.6%) and 16 (57.1%) relapsed, respectively (p < 0.05). Active intervention significantly reduced relapse rates, although no significant difference was reached between the groups overall. Thus, FC-levels might be used to identify patients with UC at risk for a flare, and a dose escalation of their 5-ASA agent is a therapeutic option for these patients.
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    ABSTRACT: Crohn's disease and ulcerative colitis are characterized by periods of symptomatic relapse and remission. Diagnosis and assessment of inflammatory bowel disease has so far been based on clinical evaluation, serum parameters, radiology and endoscopy. Faecal markers such as calprotectin or lactoferrin have emerged as new diagnostic tools to detect and monitor intestinal inflammation. This review focuses on their potential clinical applications and limitations in the management of inflammatory bowel disease.
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    ABSTRACT: The study aimed to compare the accuracy of selected biologic markers in assessing the disease activity in patients with Crohn's disease (CD). The analysis included serum IL-2, IL-6, IL-17, TNF-a, IFN-g, hsCRP, peripheral CD4 + CD25 + FOXP3 + regulatory T cells, as well as fecal calprotectin and lactoferrin. A group of 55 adults with CD was enrolled to the study. Disease activity was assessed using Crohn's Disease Endoscopic Index of Severity (CDEIS), which currently represents the gold standard for the evaluation of endoscopic activity. For clinical activity scoring, the Crohn's Disease Activity Index (CDAI) was used. Concentrations of investigated markers were estimated by means of flow cytometry and enzyme-linked immunosorbent assays, and the results were correlated with both indices. The study demonstrated that both fecal markers, i.e. calprotectin (r ¼ 0.827, p50.001) and lactoferrin (r ¼ 0.704, p50.001), correlate closely with CDEIS score, and might be used to evaluate the severity of CD in clinical setting. The correlation of those markers with CDAI was also significant, with r ¼ 0.742 for calprotectin (p50.001) and r ¼ 0.675 for lactoferrin (p50.05). As for the other investigated markers, only hsCRP (r ¼ 0.672, p50.001) and IL-17 (r ¼ 0.296, p50.005) correlated closely with CDEIS. The correlation of the markers with CDAI was also significant, though weaker, with r ¼ 0.518 for hsCRP (p50.001) and r ¼ 0.296 for IL-17 (p50.05). The study showed that IL-17, despite its vague role in the pathogenesis of CD, might be a useful marker, comparable with hsCRP, in assessing the activity of the disease.
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