Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels

Magro, Fernando; Lopes, Joanne; Borralho, Paula; Lopes, Susana; Coelho, Rosa; Cotter, José; Castro, Francisca Dias de; Sousa, Helena Tavares de; Salgado, Marta; Andrade, Patrícia; Vieira, Ana Isabel; Figueiredo, Pedro; Caldeira, Paulo; Sousa, A; Duarte, Maria Antónia; Ávila, Filipa; Silva, João; Moleiro, Joana; Mendes, Sofia; Giestas, Sílvia; Ministro, Paula; Sousa, Paula; Gonçalves, Raquel; Gonçalves, Bruno; Oliveira, Ana Maria; Rosa, Isadora; Rodrigues, Marta; Chagas, Cristina; Dias, Cláudia Camila; Afonso, Joana; Geboes, Karel; Carneiro, Fátima

doi:10.1136/gutjnl-2017-315545

Cited by 86 publications

(85 citation statements)

References 34 publications

(6 reference statements)

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“…The high rate of SP and NPV was reached in the study of Magro et al with a cut‐off level >100 μg/g (100% for both the values). Five studies assessed the correlation between FC and histology in patients with quiescent disease. Disease remission was defined by clinical scores or clinical scores combined with endoscopic ones and was different in each study.…”

Section: Resultsmentioning

confidence: 99%

“…Inflammation was diagnosed by histologic analysis in over 200 patients (>28%). This value depended on the definition of histologic remission used by Magro et al In the individual studies microscopic inflammation was found in a percentage of patients ranging from 11.6% to 57.1%, although they were considered in disease remission. Several FC cut‐off points were found to predict the presence or absence of histologic activity with a high degree of accuracy.…”

Section: Resultsmentioning

confidence: 99%

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Review article: faecal calprotectin and histologic remission in ulcerative colitis

D’Amico

Bonovas

Danese

et al. 2020

Aliment Pharmacol Ther

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Summary Background Histologic healing is emerging as a new therapeutic goal in both routine practice and clinical trials in ulcerative colitis (UC). However, it requires repeated endoscopies and biopsies. Faecal calprotectin is a non‐invasive marker of mucosal healing (endoscopic and histologic healing). Aim To conduct a systematic review to clarify the correlation between faecal calprotectin levels and histologic activity in UC patients. Methods We searched PubMed/MEDLINE, EMBASE and Web of Science through September 2019 to identify studies in patients with confirmed diagnosis of UC, reporting the correlation between faecal calprotectin levels and histologic analysis. Results Twelve studies enrolling 1168 patients were included in the final review. Histologic remission was defined according to nonvalidated scores in five articles and using partially validated scores in seven articles. Faecal calprotectin values were measured in 6 of 12 studies (50%) with the same kit, while the remaining six studies adopted individually different kits. A clear correlation between faecal calprotectin levels and histology was showed in all included studies. Eleven different faecal calprotectin cut‐off points were identified to distinguish histological remission from histological activity, ranging from 40.5 to 250 μg/g. Conclusions Faecal calprotectin can be used to predict histologic remission in patients with UC, but the cut‐off level varies across studies, according to the test used to measure this biomarker and according to the definition of histologic remission. Larger prospective studies using validated histologic indexes are needed to identify a globally accepted faecal calprotectin cut‐off level to discriminate between histologic remission and histologically active disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Review article: faecal calprotectin and histologic remission in ulcerative colitis

D’Amico

Bonovas

Danese

et al. 2020

Aliment Pharmacol Ther

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“…FCP levels above 50 μg/g of stool have been associated with pouchitis, but validation studies in this patient group are not available [19]. Also in patients with UC, levels between 200 and 250 μg have been associated with significant histologic inflammation [20]. At inclusion in our study, FCP levels were between > 50 and < 250 μg/g of stool, respectively, in 5 out of 6 (83%) of the patients.…”

Section: Discussionmentioning

confidence: 94%

Combined Endoscopic and Oral Fecal Microbiota Transplantation in Patients with Antibiotic-Dependent Pouchitis: Low Clinical Efficacy due to Low Donor Microbial Engraftment

et al. 2019

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Background and Objective: A significant number of pouch patients develop antibiotic-dependent pouchitis (ADP). Microbial dysbiosis is thought to be a major driver of clinical symptoms in ADP. The objective of this proof of concept study was to evaluate safety, efficacy, and donor microbial engraftment of an intensified fecal microbiota transplant (FMT) consisting of a single endoscopic FMT followed by daily oral FMT for 2 weeks in patients with ADP. Methods: We performed a prospective placebo-controlled double-blind FMT trial in patents with established ADP and planned to enroll 20 patients in this proof of concept study. In case of non-response, patients were offered an optional open label active FMT treatment. The endpoints were safety, clinical remission without need for antibiotics during 16 weeks of follow-up, quantitative changes of fecal calprotectin (FCP), and engraftment of donor FMT as determined by metagenomic sequencing of the V4 region of the 16S rRNA gene. Results: Due to a lower than expected clinical remission rate and low FMT engraftment, enrollment in the study was stopped prematurely after 6 patients were included. All 6 patients enrolled in the placebo-controlled portion failed to respond and needed antibiotic rescue therapy shortly after FMT. FCP increased in the majority of patients in the setting of relapse after FMT. In the active open label FMT extension study 1 out of 5 patients achieved antibiotic-free clinical remission. FMT engraftment after active FMT was observed only in this single patient, whereas engraftment of donor FMT occurred in none of the other patients receiving active FMT, paralleling the lack of clinical response. Conclusions: Low donor FMT engraftment resulted in low clinical efficacy of FMT in patients with ADP. Before embarking on larger clinical trials with FMT in patients with ADP or other forms of pouchitis, it is mandatory to explore approaches for superior FMT engraftment.

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“…Calprotectin is released by granulocyte activation and elevated level of fecal calprotectin (FC) is found in the GI tract inflammation that closely related to inflammatory bowel disease (IBD) activity . Increasing evidence indicates that FC can be used as a noninvasive marker for intestinal/colonic inflammation that helps clinicians distinguish organic inflammatory bowel disease (IBD) from functional irritable bowel syndrome (IBS) . Markers of systemic inflammation, such as C‐reactive protein (CRP) and white blood cells count, have low specificity and sensitivity for IBD, while the gold standard of ileo‐colonoscopy is invasive and expensive .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a fluorescent immunochromatography test for fecal calprotectin

Zhao

Dong

et al. 2019

Clinical Laboratory Analysis

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Background Fecal calprotectin (FC) is widely used to discriminate between patients with inflammatory diseases such as inflammatory bowel disease (IBD) and functional diseases such as irritable bowel syndrome (IBS). ELISA is a time‐consuming method for the measurement of FC, whereas a fluorescent immunochromatography test can obtain results in around 30 minutes and thus enables a rapid response to clinical decision. Methods Two methods, the Proglead® calprotectin (FC Proglead) and the BÜHLMANN fCAL® ELISA (FC BÜHLMANN), were used to quantitatively examine FC in 111 stool samples. The comparison and bias estimation of both assays were assessed using CLSI EP09c protocol. Results The two methods were highly correlated (rho = .96). Deming regression was employed to calculate the regression equation, with a slope of 1.01 and an intercept of −4.98 μg/g. The estimated median bias (FC Proglead − FC BÜHLMANN) was −4.19 μg/g with the 95% limits of agreement (−55.59 to 47.21 μg/g), and the estimated median percent bias was −8.71% with the 95% limits of agreement (−50.31% to 32.90%). There was 4.50% (5/111) of values outside the 95% limits of agreement. Percent biases at the FC cutoff values of 50 and 200 μg/g between both methods evaluated by Deming regression were 8.96% and 1.49%, respectively. The biases were all less than the acceptable standard (10%). And, 99.10% of FC results were in agreement between both methods (kappa = .99, P < .001). Conclusions FC Proglead may be used as a suitable alternative to FC BÜHLMANN for the disease activity assessment for patients with IBD, considering its convenience and shorter turnaround time.

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Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels

Cited by 86 publications

References 34 publications

Review article: faecal calprotectin and histologic remission in ulcerative colitis

Review article: faecal calprotectin and histologic remission in ulcerative colitis

Combined Endoscopic and Oral Fecal Microbiota Transplantation in Patients with Antibiotic-Dependent Pouchitis: Low Clinical Efficacy due to Low Donor Microbial Engraftment

Evaluation of a fluorescent immunochromatography test for fecal calprotectin

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