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J Crohns Colitis. 2015 Dec;9(12):1113-9. doi: 10.1093/ecco-jcc/jjv150. Epub 2015 Sep 7.

Endoscopic Factors Influencing Fecal Calprotectin Value in Crohn's Disease.

Author information

1
University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France.
2
University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France UMR 1071 Inserm/Universite d'Auvergne; USC-INRA 2018, Clermont-Ferrand, France.
3
GM Clermont-Ferrand University and Medical Center, Biochemistry Unit, Clermont- Ferrand, France.
4
GM Clermont-Ferrand University and Medical Center, DRCI, Biostatistics Unit, Clermont-Ferrand, France.
5
University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France UMR 1071 Inserm/Universite d'Auvergne; USC-INRA 2018, Clermont-Ferrand, France a_buisson@chu-clermontferrand.fr.

Abstract

BACKGROUND AND AIMS:

Fecal calprotectin [fcal] is a biomarker of Crohn's disease [CD] endoscopic activity. Identifying the endoscopic situations in which fcal is less reliable remains unexplored. We aimed to determine the endoscopic factors influencing fcal level in CD.

METHODS:

Overall, 53 CD patients consecutively and prospectively underwent colonoscopy, with CD Endoscopic Index of Severity [CDEIS] calculation and stool collection. Fcal was measured using a quantitative immunochromatographic test. Correlation analysis was done with Pearson statistics.

RESULTS:

Fcal was correlated with CDEIS [0.66, p < 0.001]. In univariate analysis, fcal was correlated with the affected surface [0.65, p < 0.001] and the ulcerated surface [0.47, p < 0.001]. Fcal was significantly associated with ulceration depth, with median fcal of 867.5 µg/g, 1251.0 µg/g, and 1800.0 µg/g, in patients presenting with non-ulcerated lesions, superficial ulcerations [SU], and deep ulcerations [DU], respectively. Lesion locations did not influence fcal. In multivariate analysis, fcal was associated with affected surface [p = 0.04] and the presence of CD lesions. Moreover, fcal increased with the ulceration depth [p = 0.03]. However, ulcerated surface and CD location did not affect fcal. Using a receiver operating characteristic [ROC] curve, we showed that fcal of 400 µg/g was the best compromise between sensitivity [0.76] and specificity [0.77], whereas fcal ≥ 200 µg/g was highly sensitive [0.86] to detect SU or DU.

CONCLUSIONS:

Fcal is a very reliable biomarker to detect endoscopic ulcerations in CD. We suggest repeating measurement in case of intermediary results [200-400 µg/g] in daily practice. Fcal level is mostly influenced by the presence of CD lesions [even non-ulcerated], in a depth-related manner and by the affected surface.

KEYWORDS:

Crohn’ s disease; Crohn’s Disease Endoscopic Index of Severity; biomarker; endoscopy; fecal calprotectin

PMID:
26351383
DOI:
10.1093/ecco-jcc/jjv150
[Indexed for MEDLINE]

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