Can Calprotectin Predict Relapse Risk in Inflammatory Bowel Disease?

Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
The American Journal of Gastroenterology (Impact Factor: 10.76). 09/2008; 103(8):2007-14. DOI: 10.1111/j.1572-0241.2008.01870.x
Source: PubMed


Assessing the clinical course of inflammatory bowel disease (IBD) patients consists of periodical clinical evaluations and laboratory tests. We aimed to assess the role of calprotectin tests in predicting clinical relapse in IBD patients.
Ninety-seven patients with ulcerative colitis (UC) and 65 with Crohn's disease (CD) in clinical remission were prospectively included in the study. A 10-g stool sample was collected for calprotectin assay. The cutoff level was set at 130 mg/kg of feces. Patients were followed up for 1 yr after the test or until relapse. The cumulative proportion of relapses was estimated by the Kaplan-Meier analysis. Statistics for equality of survival distribution were tested using the log-rank test.
The calprotectin test was positive in 44 UC patients and 26 of them relapsed within a year, while 11 of 53 UC patients with a negative calprotectin test relapsed within the same time frame. Thirty CD patients had a positive calprotectin test and 13 of them relapsed within a year, as did 7 of the 35 with a negative test result. A significant correlation emerged between a positive calprotectin test and the probability of relapse in UC patients (P= 0.000). In CD patients, only cases of colonic CD showed a significant correlation between a positive calprotectin test and the probability of relapse, i.e., 6 colonic CD patients were positive for the calprotectin test and 4 relapsed (P= 0.02).
Measuring calprotectin may help to identify UC and colonic CD patients at higher risk of clinical relapse.

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    • "More recently fecal biomarkers such as fecal calprotectin and lactoferrin have shown promising results in differentiating IBD from IBS, monitoring disease activity and predicting the relapse in IBD [45], [46]. Disappointingly, these are non-specific markers of bowel inflammation as their levels are also abnormal in NSAID-induced bowel inflammation, celiac sprue, colonic polyps, diverticulitis and colorectal cancer [47], [48]. "
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    ABSTRACT: Diagnosing irritable bowel syndrome (IBS) can be a challenge; many clinicians resort to invasive investigations in order to rule out other diseases and reassure their patients. Volatile organic metabolites (VOMs) are emitted from feces; understanding changes in the patterns of these VOMs could aid our understanding of the etiology of the disease and the development of biomarkers, which can assist in the diagnosis of IBS. We report the first comprehensive study of the fecal VOMs patterns in patients with diarrhea-predominant IBS (IBS-D), active Crohn's disease (CD), ulcerative colitis (UC) and healthy controls. 30 patients with IBS-D, 62 with CD, 48 with UC and 109 healthy controls were studied. Diagnosis of IBS-D was made using the Manning criteria and all patients with CD and UC met endoscopic, histologic and/or radiologic criteria. Fecal VOMs were extracted by solid phase microextraction (SPME) and analyzed by gas chromatography-mass spectrometry (GC-MS). 240 VOMs were identified. Univariate analysis showed that esters of short chain fatty acids, cyclohexanecarboxylic acid and its ester derivatives were associated with IBS-D (p<0.05), while aldehydes were more abundant in IBD (p<0.05). A predictive model, developed by multivariate analysis, separated IBS-D from active CD, UC and healthy controls with a sensitivity of 94%, 96% and 90%; and a specificity of 82%, 80% and 80% respectively (p<0.05). The understanding of the derivation of these VOMs may cast light on the etiology of IBS-D and IBD. These data show that fecal VOMs analyses could contribute to the diagnosis of IBS-D, for which there is no laboratory test, as well as IBD.
    Full-text · Article · Mar 2013 · PLoS ONE
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    • "Tibble et al. [13] reported that 30 μg/g had 100% sensitivity in discriminating IBS from IBD. Others like D'Incà et al. [14] and Sipponen et al. [15] have found 130 and 200 μg/g, respectively, to be potential useful cutoff values for remission and activity. In a recently published paper by Sipponen's group [10], the best cutoff value for endoscopic remission was found to be 94 μg/g. "
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    ABSTRACT: and Aim . In the inflammatory bowel diseases (IBDs), many symptoms are similar to the functional disorder irritable bowel syndrome (IBS). A challenge is thus to distinguish symptoms of IBD from IBS. The aim of this study was to investigate the levels of calprotectin in IBS-positive IBD patients in remission. Methods . Remission was defined as a simple clinical colitis activity index (SCCAI) or simple crohn’s disease activity index (SCDAI) score of less than three and less than four, respectively. The Rome II criteria were used to identify cases, and the calprotectin ELISA test was used to quantify calprotectin in stools. Results . The Rome II criteria were fulfilled in 24.6% of ulcerative colitis (UC) patients, while the comparable number for Crohn's disease (CD) was 21.4%. There was a tendency for elevated fecal calprotectin levels in IBS-positive patients, regardless of diagnosis. However, these differences were only significant in CD. Conclusions . Calprotectin levels are elevated in subgroups of IBD patients that are in remission and have coexisting IBS-like symptoms. This study underscores the clinical usefulness of a noninvasive marker to distinguish patients in need of intensified followup from those that do not need further workup.
    Full-text · Article · Feb 2013 · Gastroenterology Research and Practice
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    • "They did not find CRP or ESR to be useful in predicting relapse of IBD (Tibble et al., 2000b). Other studies have confirmed the results of Tibbel et al (Costa et al., 2005; D'Inca et al., 2008). "

    Full-text · Chapter · Nov 2011
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