Does fecal calprotectin equally and accurately measure disease activity in small bowel and large bowel Crohn’s disease?: a systematic review

Abstract

Fecal calprotectin (FC) is a highly sensitive disease activity biomarker in inflammatory bowel disease. However, there are conflicting reports on whether the diagnostic accuracy in Crohn’s disease is influenced by disease location. The aim of this study was to undertake a systematic review of the published literature. Relevant databases were searched from inception to November 8, 2016 for cohort and case control studies which had data on FC in patients with isolated small bowel (SB) and large bowel (LB) Crohn’s disease. Reference standards for disease activity were endoscopy, magnetic resonance imaging, computed tomography or a combination of these. The QUADAS-2 research tool was used to assess the risk of bias. There were 5,619 records identified at initial search. The 2,098 duplicates were removed and 3,521 records screened. Sixty-one full text articles were assessed for eligibility and 16 studies were included in the final review with sensitivities and specificities per disease location available from 8 studies. Sensitivities of FC at SB and LB locations ranged from 42.9% to 100% and 66.7% to 100% respectively while corresponding specificities were 50% to 100% and 28.6% to 100% respectively. The sensitivities and specificities of FC to accurately measure disease activity in Crohn’s disease at different disease locations are diverse and no firm conclusion can be made. Better studies need to be undertaken to categorically answer the effect of disease location on the diagnostic accuracy of FC.

Diagnostic Accuracy of Fecal Calprotectin for the Detection of Small Bowel Crohn's Disease through Capsule Endoscopy: An Updated Meta-Analysis and Systematic Review

“…FC is a useful surrogate marker to detect bowel inflammation and to diagnose and monitor patients with inflammatory bowel diseases. 22,[41][42][43][44][45] Mosli et al 42 reported that endoscopic activity in symptomatic patients with inflammatory bowel diseases could be detected by FC with a pooled sensitivity of 0.88 (95% CI, 0.84 to 0.90) and specificity of 0.73 (95% CI, 0.66 to 0.79). Another recent meta-analysis showed that an FC cutoff of 150 μg/g could be used to detect a postoperative endoscopic recurrence of Crohn's disease (pooled sensitivity was 0.70 [95% CI, 0.59 to 0.81], specificity, 0.69 [95% CI, 0.61 to 0.77], and DOR, 5.92 [95% CI, 2.61 to 12.17]).…”

Multiomic features associated with mucosal healing and inflammation in paediatric Crohn’s disease

“…A sensitivity analysis which excluded patients with “borderline” faecal calprotectin values was performed to address this and confirmed all findings from the primary analysis. There is additional concern the accuracy of faecal calprotectin may be lower in ileal disease, 9 but in this cohort only one patient had isolated ileal disease and they had a very raised calprotectin level over 2000 μg/g.…”

“…Low faecal calprotectin levels are a well validated non‐invasive marker of mucosal healing in CD 3‐6 . The faecal calprotectin threshold which defines mucosal healing has not been universally agreed, studies support values in the range of 100‐300 μg/g, 3‐8 with a value of 100 μg/g used most frequently 9 . In paediatric CD Weinstein‐Nakar et al 7 found faecal calprotectin levels under 100 μg/g were predictive of mucosal and transmural healing.…”

Predicting disease course in ulcerative colitis using stool proteins identified through an aptamer-based screen

“…The sensitivity and specificity of fecal calprotectin testing are dependent on the location of the inflammation. Several studies reported lower specificity in CD patients versus UC patients, and higher specificity for large bowel disease versus small bowel disease 24 . Approximately 80% of CD patients have ileal involvement and up to 32% have isolated small bowel disease.…”