International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases

Abstract

Background: Fecal calprotectin (FC) is a non-invasive marker of gut inflammation which is frequently used to guide therapeutic decisions in patients with inflammatory bowel diseases (IBD). Each step of FC measurement can influence the results, leading to misinterpretations and potentially impacting the management of IBD patients. To date, there is high heterogeneity between FC measurements and no current method is universally accepted as a standard.Aims: Our aim was to provide clear position statementsabout the pre-analytical and the analytical phases of FC measurement to homogenize FC levels and to minimize variability and risk of misinterpretation through aninternational consensus.Materials & Methods: Fourteen physicians with expertise in the field of IBD and FC from 11 countries attended a virtual international consensus meeting on July 17th, 2020. A systematic literature was conducted and the literature evidence was shared and discussedamong the participants. Statements were formulated, discussed, and voted. Statements were considered approved if all participants agreed.Results: Nine statements were formulated and approved. Based on the available evidence, quantitative tests should be preferred for measuring FC. Furthermore, FC measurement, if possible, should always be performed with the same method and factors influencing FC levels should be taken into account when interpreting the results.Discussion: FC has an increasingly important role in the management of patients with IBD. However, large multicenter studies should be conducted to define the reproducibility and to confirm the diagnostic accuracy of the available FC tests.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Exploring the concept of deep remission in Crohn’s disease: correlation between transmural healing and biomarkers

“…It is known that FC can significantly vary in individual patients on a day-to-day basis or even in two different samples taken on the same day. 47 We never use FC alone in clinical practice for IBD management: the FC value of 94 μg/g has to be associated with predictive values of TH and MH.…”

Point-of-Care Testing and Home Testing: Pragmatic Considerations for Widespread Incorporation of Stool Tests, Serum Tests, and Intestinal Ultrasound

“…The optimal cut-off value of FC remains to be found. 42 Levels <250 mg/g indicate endoscopic remission in patients with CD and UC. 43 This cut-off is widely used in clinical practice as a threshold for adjusting treatment or performing further investigations.…”

“…52 FC in different stool samples varies during the same day. 42 Some 53 recommend collecting stool samples from the first bowel movement in the morning, whereas others recommend the same time a day in successive measurements. 42 However, disinclination to collect stool for FC, forgetfulness, or lack of perceived test benefit leads to 30%-40% compliance rates.…”

“…42 Some 53 recommend collecting stool samples from the first bowel movement in the morning, whereas others recommend the same time a day in successive measurements. 42 However, disinclination to collect stool for FC, forgetfulness, or lack of perceived test benefit leads to 30%-40% compliance rates. 54,55 Recently, FC home tests have become available, allowing patients to measure FC levels remotely.…”

Guidelines, top‐notch science & social media—Jump on the bandwagon

“…Another aspect of using SoMe platforms in 2021 was releasing eight episodes of the UEG Journal podcast series, giving voice to the authors, allowing for the entire route of their study process presentationfrom the initial idea to the final publication of the paper. 6,7,[20][21][22][23][24][25] The New Year is accompanied by new intentions and resolutions for further improving UEG Journal's presence in SoMe and thus continuing to provide the best access to top-notch science.…”