"Calprotectin decreases significantly after IFX treatment for 12 weeks, and it correlated with endoscopic index of severity (CDEIS) (r = 0.561, P = 0.03) . Røseth et al. show that fecal calprotectin level correlated with endoscopic mucosal healing . A meta-analysis focusing on fecal calprotectin in IBD relapse shows that the sensitivity and specificity when predicting the relapse are 78% and 73%, separately . "
[Show abstract][Hide abstract] ABSTRACT: Inflammatory bowel disease (IBD) is a chronic disease mostly involved with intestine with unknown etiology. Diagnosis, evaluation of severity, and prognosis are still present as challenges for physicians. An ideal biomarker with the characters such as simple, easy to perform, noninvasive or microinvasive, cheap, rapid, and reproducible is helpful for patients and clinicians. Currently biomarkers applied in clinic include CRP, ESR, pANCA, ASCA, and fecal calprotectin. However, they are far from ideal. Lots of studies are focused on seeking for ideal biomarker for IBD. Herein, the paper reviewed recent researches on biomarkers of IBD to get advances of biomarkers in inflammatory bowel disease.
"The measurement of fecal calprotectin (FC), a surrogate marker of mucosal inflammation, is of interest as a possible means of predicting the course of biological treatment in individual patients. Several publications showed that, in adult patients with Crohn's disease and UC, low FC levels associate with a low degree of inflammation  . In Correspondence: Kaija-Leena Kolho, MD PhD, Children's Hospital, Helsinki University Central Hospital, Box 281, FIN-00029 HUS, Finland. "
[Show abstract][Hide abstract] ABSTRACT: Objective:
Monitoring fecal calprotectin (FC) could assist in the assessment of the therapeutic response of inflammatory bowel disease (IBD). There are few studies on long-term prognosis related to the FC value response to infliximab induction therapy, thus providing the aim of this study on pediatric patients.
FC levels were measured during the induction and maintenance phase of infliximab therapy (5 mg/kg) in 76 pediatric IBD patients introduced to maintenance therapy. The long-term outcomes and clinical disease activity were retrospectively related to the FC response to induction.
The median pretreatment FC level of 817 μg/g stool (range <5-24,000) declined to 372 μg/g (range 5-2430) by week 6, with a low level (<100 μg/g) in 35% (pooled comparable data for ulcerative colitis and Crohn's). Clinical activity indices showed remission in 59% (pediatric Crohn's disease activity index: <10, n = 33; pediatric ulcerative colitis activity index: <10 n = 12). In 49 patients (64%), infliximab therapy was discontinued (inadequate effect/surgery = 27; remission/bridging to azathioprine = 12; adverse effect = 6; antibodies to infliximab n = 4) during the study period with a median follow up of 1.1 years (interquartile range [IQR]: 0.71-4.4). Those who discontinued the therapy within the first year due to an inadequate effect had higher median FC level during induction than the other patients (median 633 µg/g, IQR: 197-819 and median 219 µg/g, IQR: 71-508, respectively; p < 0.025) and were less frequently in clinical remission at week 6 (p < 0.01).
The long-term prognosis of infliximab therapy is related to the response to induction therapy in pediatric IBD and reflected in low FC values between weeks 2 and 6 and clinical remission.
"In the study by Ricanek et al. the association between SCCAI and endoscopic grade of inflammation was studied, and patients with SCCAI scores of 6 and 7 had moderate or severe inflammation, respectively, according to the Mayo endoscopic subscore . This study also confirms previous observations that very high levels of FC are found in active UC, with a median value of 2737 mg/kg prior to steroid treatment  . The levels of FC in our study are significantly higher compared to the values found in the study by Ho et al., although the levels of FC fall rapidly during the first days of steroid treatment. "
[Show abstract][Hide abstract] ABSTRACT: Objective:
Monitoring active ulcerative colitis (UC) is essential for making correct and timely treatment decisions. The current monitoring is based on symptom scores and biochemical markers, among which the role of fecal calprotectin (FC) is debated. The aims were to assess the development in FC during steroid treatment and to compare FC with symptom scores and biochemical markers.
Material and methods:
A prospective observational study, including 16 patients with active UC requiring high-dose steroid treatment. FC, C-reactive protein (CRP), leukocytes, hemoglobin, albumin, and simple clinical colitis activity index (SCCAI) were assessed before the initiation of treatment, as well as on days 2, 6, 13, and 27. The one-year follow-up data were retrospectively obtained.
All patients had significant decreasing levels of FC (-1014 mg/kg, p = 0.0061), CRP (-10 mmol/l, p = 0.0313), and SCCAI (-3, p = 0.0002) during the first 4 days. After 27 days, the FC had decreased to 216 mg/kg (p = 0.002). A significant correlation between the changes in CRP and SCCAI was found (r(s) = 0.65, p = 0.03) but not between FC and CRP or SCCAI. Overall, significant correlations between absolute levels of FC, CRP, and SCCAI were found. Levels of FC on day 0 and day 4 were not predictive of sustained clinical remission at 1-year follow up.
FC, CRP, and SCCAI seem to be reliable markers of treatment response during steroid treatment. High initial levels of FC and a subsequent rapid reduction during steroid treatment were identified. FC levels were not found to be predictive of disease prognosis after one year.
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