Clinical application of faecal calprotectin in ulcerative colitis patients

Scaioli, Eleonora; Scagliarini, Michele; Cardamone, Carla; Liverani, Elisa; Ugolini, Giampaolo; Festi, Davide; Bazzoli, Franco; Belluzzi, Andrea

doi:10.1097/meg.0000000000000461

Cited by 24 publications

(14 citation statements)

References 26 publications

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“…It can, however, be argued that complete normalization of FC—potentially indicating complete resolution of macroscopic and microscopic inflammation—is a therapeutic target beyond mucosal healing. In support of this, recent studies in adults have shown that even in the absence of endoscopic signs of disease activity, levels of FC are predictive of long-term outcome [ 28 , 20 ]. Furthermore, a therapeutic algorithm based on levels of FC alone did improve medium-term outcome in adults with IBD [ 24 , 26 ].…”

Section: Introductionmentioning

confidence: 89%

Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

et al. 2016

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In adult inflammatory bowel disease (IBD) patients, there is a strong discrepancy between symptoms and biomarkers of inflammation. Data on pediatric IBD patients are conflicting. Therefore, we aimed to investigate the relationship between clinical symptoms and biomarkers of inflammation in pediatric IBD. Patients aged <18 years with previously diagnosed Crohn’s disease (CD) or ulcerative colitis (UC) were included. Clinical disease activity was determined using the abbreviated Pediatric CD Activity Index (aPCDAI) or Pediatric UC Activity Index (PUCAI). Biochemical disease activity was assessed using fecal calprotectin (FC) and C-reactive protein (CRP). In total, 127 patients (62 male; median age 14.9 years) were included (82 CD, 45 UC). FC correlated weakly with total aPCDAI score (rs = 0.32; 95 % CI 0.12–0.51; p = 0.003) and total PUCAI score (rs = 0.36; 95 % CI 0.07–0.62; p = 0.015). Only aPCDAI components abdominal examination and perirectal disease and PUCAI component activity level had a significant correlation with levels of FC. CRP correlated weakly with total aPCDAI score (rs = 0.28; 95 % CI 0.05–0.46; p = 0.012) and aPCDAI components abdominal examination and activity level. No significant correlation was observed between CRP and total PUCAI score (rs = 0.01; 95 % CI −0.34–0.29; p = 0.961) or individual PUCAI components.Conclusion: There is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD. What is Known: • A substantial proportion of asymptomatic pediatric inflammatory bowel disease (IBD) patients have elevated biomarkers of inflammation.• There is a strong discrepancy between symptoms and biomarkers of inflammation in adults with IBD. What is New: • Clinical symptoms are only weakly associated with levels of fecal calprotectin and serum C-reactive protein in children and adolescents with previously diagnosed IBD.• Similarly to adult IBD patients, there is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-016-2762-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 89%

Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

et al. 2016

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“…Quantification of FC was carried out using CalFast (Eurospital, Trieste, Italy) according to the manufacturer’s protocol. FC values > 150 μg/g were considered predictive of mucosal endoscopic activity as previously demonstrated 53 .…”

Section: Methodsmentioning

confidence: 99%

“…Eligible patients were asymptomatic subjects aged 18–70 years with long-standing (≥ 8 years) UC, in stable clinical remission (simple clinical colitis activity index; SCCAI = 0), and FC levels higher than 150 µg/g 53 . Patients were included in the study after signing the informed written consent.…”

Section: Methodsmentioning

confidence: 99%

Short-term treatment with eicosapentaenoic acid improves inflammation and affects colonic differentiation markers and microbiota in patients with ulcerative colitis

Prossomariti

Scaioli

Piazzi

et al. 2017

Sci Rep

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Patients with long-standing ulcerative colitis (UC) have an increased colorectal cancer (CRC) risk. In this pilot study we evaluated the effect of Eicosapentaenoic acid as free fatty acid (EPA-FFA) supplementation on mucosal disease activity, colonic differentiation markers and microbiota composition in UC patients. Twenty long-standing UC patients in stable clinical remission and with fecal calprotectin (FC) > 150 µg/g were enrolled (T0) and supplemented with EPA-FFA 2 g/daily for 90 days (T3). Endoscopic and histologic disease activities were measured by Mayo and Geboes scores, respectively. HES1, KLF4, STAT3, IL-10 and SOCS3 levels were determined using western blotting and qRT-PCR, while phospho-STAT3 levels were assessed by western blotting. Goblet cells were stained by Alcian blue. Microbiota analyses were performed on both fecal and colonic samples. Nineteen patients completed the study; seventeen (89.5%) were compliant. EPA-FFA treatment reduced FC levels at T3. Patients with FC > 150 µg/g at T3 (n = 2) were assumed as non-responders. EPA-FFA improved endoscopic and histological inflammation and induced IL-10, SOCS3, HES1 and KLF4 in compliant and responder patients. Importantly, long-term UC-driven microbiota composition was partially redressed by EPA-FFA. In conclusion, EPA-FFA supplementation reduced mucosal inflammation, promoted goblet cells differentiation and modulated intestinal microbiota composition in long-standing UC patients.

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“…Active vs inactive disease. Overall, 8 studies only included patients with active disease (Lewis et al, 19 Dhanda et al, 20 Jharap et al, 21 Scaioli et al, 23 Seo et al, 3 Achitei et al, 24 Mirpour et al, 25 Jairath et al 1 ), whereas 15 studies included patients with both active and inactive disease (Bodelier et al, 26 Schoepfer et al, 27 Pagnini et al, 28 Beattie et al, 7 Azzolini et al, 12 Hirai et al, 29 Langhorst et al, 30 Arai et al, 31 Higging et al, 32 Ricanek et al, 33 Samuel et al, 34 Taleban et al, 35 Falvey et al, 36 Chen et al, 37 and Colombel et al 22 ). Unfortunately, the published data do not provide information for active vs inactive disease separately.…”

Section: Association Between Clinical Symptoms and Endoscopy In The Dmentioning

confidence: 99%

Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

Restellini

Chen

Martel

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Optimal management of patients with ulcerative colitis (UC) requires assessment of disease activity-usually by endoscopy, which is invasive, costly, and not risk free. We performed a systematic review to determine whether clinical symptoms correlate with findings from endoscopy assessments of patients with UC. METHODS: We performed a systematic review of publication databases from January 1980 through July 2018 to identify clinical trials and observational studies reporting correlations among symptoms, disease activity index scores and/or patient reported outcomes (rectal bleeding and/or stool frequency), and endoscopic disease activity. Correlations were ascertained in patients with active vs inactive disease and by disease extent and treatment type. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Because of significant heterogeneity, meta-analysis was not possible. Results were synthesized qualitatively and systematically. RESULTS: Our final analysis included 23 studies (1 randomized trial, 22 observational studies) comprising 3320 patients with UC. The studies used a variety of measures to assess clinical activity, endoscopic activity, and measures of correlation (sensitivity, specificity, correlation coefficients, area under the receiver operator curve). Overall, studies were at moderate-high risk of bias. Composite clinical measures, including rectal bleeding and stool frequency, had moderate to strong correlations with endoscopic disease activity; the absence of rectal bleeding identified patients with inactive disease with higher levels of sensitivity than normalization of stool frequency. In general, symptoms correlated more strongly with endoscopic activity in patients with left-sided colitis than extensive colitis. The effect of different medications on the correlation between clinical and endoscopic activity has not been well studied. CONCLUSIONS: In a systematic review, we found a moderate to strong correlation between clinical activity, particularly the combination of rectal bleeding and stool frequency, and endoscopic activity in patients with UC. Although these clinical assessments could help prioritize patients for endoscopic evaluation in resource-limited settings, challenges associated with treating patients based on symptoms alone preclude adaptation of current management algorithms.

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Clinical application of faecal calprotectin in ulcerative colitis patients

Abstract: Our data strongly support the use of FC for staging the activity of disease, predicting relapse and leading decision-making in a UC setting.

Cited by 24 publications

References 26 publications

Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

Short-term treatment with eicosapentaenoic acid improves inflammation and affects colonic differentiation markers and microbiota in patients with ulcerative colitis

Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

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