A Patient Self-Made Point-of-Care Fecal Test Improves Diagnostic Accuracy Compared with Fecal Calprotectin Alone in Inflammatory Bowel Disease Patients

Abstract

Background: Monitoring inflammatory bowel disease patients may be challenging. Fecal calprotectin is one of the most performed tests. Other fecal biomarkers are less used in clinical practice. Rapid fecal tests that could be performed by patients may be a useful strategy to closely monitor disease activity. Methods: We performed a prospective observational study including consecutive inflammatory bowel disease patients referred for colonoscopy in a single center. Certest FOB + Transferrin + Calprotectin + Lactoferrin® (Certest Biotec S.L, Zaragoza, Spain), a one-step point-of-care test which simultaneously detects these four biomarkers was performed. Endoscopic inflammatory activity was defined using the Mayo score (≥1) in ulcerative colitis, SES-CD (>3) and Rutgeerts scores (≥1) for Crohn’s disease. Results: Out of a total of 106 patients (56.5% female, mean age 51 years), 54 (50.9%) were diagnosed with ulcerative colitis and 52 (49.1%) with Crohn’s disease. Endoscopic activity was detected in 42 patients (39.0%). Fecal calprotectin provided the best sensitivity (97.6%), with limited specificity (34.4%). Compared to calprotectin, the other 3 fecal biomarkers showed better specificity (87.5–92.1%) and lower sensitivity (45.2–59.5%). Patients with a negative result in all biomarkers (19/106—17.9%) had 100% (CI 95% 97.4–100) negative predictive value, while patients with the 4 biomarkers positive (13/106—12.3%) had 100% (CI 95% 96.1–100) positive predictive value of endoscopic inflammatory activity. AUROC of this 4 biomarker point-of-care test was 0.845 (95% CI 0.771–0.920), significantly higher than the AUROCs of any of the 4 biomarkers. Conclusions: This test may be a useful strategy to monitor inflammatory activity in clinical practice by excluding or prioritizing patients in need of a colonoscopy.

A solitary rectal juvenile polyp with chicken skin‑like changes in the surrounding mucosa in an adult: A case report

“…Calprotectin is a nonglycosylated human protein with a molecular weight of 36.5 kDa found in high concentrations in the cytosol of neutrophil granulocytes ( 20 , 21 ). Currently, FCP is recommended as an aid in distinguishing between inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis, and non-IBD, such as irritable bowel syndrome ( 20 ).…”

“…Calprotectin is a nonglycosylated human protein with a molecular weight of 36.5 kDa found in high concentrations in the cytosol of neutrophil granulocytes ( 20 , 21 ). Currently, FCP is recommended as an aid in distinguishing between inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis, and non-IBD, such as irritable bowel syndrome ( 20 ). The present case study suggests that elevated FCP levels may be related to the presence of juvenile polyps in adults, since after endoscopic resection, FCP was found to be within the normal range.…”