Faecal Calprotectin for the Diagnosis of Bowel Inflammation in Patients With Rheumatological Diseases: A Systematic Review

Abstract

Background and Aims Endoscopic and histological gut inflammation are present in half of patients with ankylosing spondylitis [AS] or spondyloarthritis [SpA]. We performed a systematic literature review on the use of faecal calprotectin [FC] in patients with rheumatic diseases. Methods Searches of the PubMed, Web of Science, and Cochrane Library databases were performed up to September 2019 to identify all studies including adult patients with confirmed diagnosis of SpA or AS. Results Seven studies met the inclusion criteria: six prospective observational studies and one retrospective observational study. Study populations consisted of SpA patients in four studies and AS patients in three studies. In six studies, an ELISA test was used for FC levels and in one case, a semi-quantitative assay was adopted. In all included studies, patients with SpA or AS had elevated FC levels, ranging from 21.2% to 70.7% of patients. In six studies, patients with increased FC levels had macroscopic mucosal inflammation, ranging from 11% to 80% of cases. Four studies highlighted the presence of microscopic alterations in patients with high FC levels, ranging from 41.7% to 100% of patients. An FC cut-off level predicting the inflammatory bowel disease [IBD] occurrence was found in two studies: 266 mg/kg and 132 mg/kg, with sensitivity and specificity of 100%, 78.7% and 66.7%, 76.9%, respectively. Conclusions Faecal calprotectin is a useful and non-invasive marker to predict IBD in patients with SpA or AS. Gut histological and macroscopic mucosal inflammation were found in up to 100% and 80% of rheumatological patients with increased FC levels.

Paradoxical gastrointestinal effects of interleukin-17 blockers

“…39 40 85 In addition, all patients should be informed of the possible risk of gastrointestinal adverse effects, and as some patients might have subclinical bowel inflammation, faecal calprotectin (FC) levels should be measured to detect gut inflammation, enabling patients to be stratified and guiding physicians' decisions. 86 Normal FC values (<250 µg/g 87 ) should authorise treatment with anti-IL-17 drugs, although tight monitoring remains essential to exclude the appearance of new digestive symptoms, to enable early treatment interruption, and to refer the patient for gastroenterological consultation. If FC is elevated (>250 µg/g), 87 a gastroenterological evaluation should be indicated to assess the need for complementary procedures (eg, colonoscopy or MRE) and to newly diagnose IBD.…”

Biomarkers of Inflammation in Inflammatory Bowel Disease: How Long before Abandoning Single-Marker Approaches?

“…Confidence for the application of this approach is the consequence of data showing the high negative predictive value (>90%) of FC in this setting for levels <100 μg/g [29, 68]. Interestingly, a recent systematic review studied the ability of FC to predict the development of IBD in patients with rheumatologic conditions, including ankylosing spondylitis and spondyloarthritis: endoscopic and histologic inflammation in the intestine was found in up to 80 and 100% of rheumatologic patients with increased FC levels, respectively [73].…”

Pharmacologic treatment of GERD: Where we are now, and where are we going?

“…56 In addition, the proinflammatory microbiota profile during PPI treatment is accompanied by an increase in fecal calprotectin, 57 a mucosal inflammation biomarker, which is elevated in patients with IBD in relation to disease activity. 58 Finally, PPI use is associated with adverse outcomes in patients with IBD. 59,60 Both the proinflammatory microbiota profile and alterations in mucosal permeability may predispose to Clostridium difficile infection, microscopic colitis, and IBD, all of which have been reported to increase with long-term PPIs.…”

“…PPI‐induced gut dysbiosis 55 is common in inflammatory bowel disease (IBD) 56 . In addition, the proinflammatory microbiota profile during PPI treatment is accompanied by an increase in fecal calprotectin, 57 a mucosal inflammation biomarker, which is elevated in patients with IBD in relation to disease activity 58 . Finally, PPI use is associated with adverse outcomes in patients with IBD 59,60 .…”