Profile of Consecutive Fecal Calprotectin Levels in the Perioperative Period and Its Predictive Capacity for Early Endoscopic Recurrence in Crohn’s Disease

Abstract

BACKGROUND: The perioperative behavior of fecal calprotectin and whether it predicts early postoperative endoscopic recurrence of Crohn’s disease are unknown. OBJECTIVE: We aimed to compare the perioperative profiles of fecal calprotectin between patients with Crohn’s disease and patients without Crohn’s disease undergoing intestinal resection and to identify the association between consecutive fecal calprotectin levels and endoscopic recurrence 3 months after surgery in patients with Crohn’s disease. DESIGN: This was a prospective observational study. SETTINGS: This study was conducted in a tertiary referral hospital. PATIENTS: One hundred fourteen consecutive patients (90 Crohn’s disease, 24 non-Crohn’s disease) who underwent resection were recruited. MAIN OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify variations and risk factors. The predictive accuracy of the possible predictors was assessed by using receiver operating characteristic curves. RESULTS: The fecal calprotectin levels on preoperative day 14 and postoperative days 14, 21, 28, 60, and 90 were higher in the Crohn’s disease group than they were in non-Crohn’s disease group (p < 0.05). Twenty patients (22.2%) developed endoscopic recurrence 3 months after resection. The trend for fecal calprotectin change (Δfecal calprotectin) from preoperative day 14 to postoperative day 14 was opposite in the recurrence and nonrecurrence groups. Multivariate analysis showed that this change was a predictive factor of early endoscopic recurrence (p < 0.05). ΔFecal calprotectin was more accurate at predicting early endoscopic recurrence than was fecal calprotectin at single time points with a cutoff value of 240 μg/g. LIMITATIONS: This is a single-center trial with a limited cohort of patients. CONCLUSIONS: The perioperative fecal calprotectin levels were higher in patients with Crohn’s disease than they were in the control group. The change in fecal calprotectin levels from preoperative day 14 to postoperative day 14 could serve as a practical predictive index for early postoperative endoscopic recurrence. See Video Abstract at http://links.lww.com/DCR/A796.

Endoscopic Evaluation at 1 Month After Ileocolic Resection for Crohn's Disease Predicts Future Postoperative Recurrence and Is Safe

“…3 Our previous study showed that postoperative Fc could predict endoscopic recurrence at 3 months after surgery. 9 In the present study, we also found Fc >150 ug/g on postoperative day 14 could predict anastomotic scattered ulcers. These indicate that Fc could be one useful tool to screen out patients at high risk of postoperative recurrence 1 month after surgery.…”

“…Histologic recurrence of CD can occur as early as 1 week after surgery. 8 In our previous study, 9 more than 20% of patients suffered endoscopic recurrence at 3 months after surgery. It is not clear whether performing the first endoscopic evaluation at 1 month after surgery is necessary and useful for treatment adjustment.…”

Real-life utility and diagnostic accuracy of a home-performed fecal calprotectin test to predict endoscopic activity in patients with inflammatory bowel disease under maintenance treatment with adalimumab

“…Consecutive elevated FC measurements in them can predict disease relapse in the upcoming 3 months with high sensitivity and specificity [5,6), thus serving as a tool to assess treatment efficacy. In addition, consecutive monitoring of FC perioperatively may be predictive of early postoperative endoscopic recurrence [7].…”

Evaluation of a fluorescent immunochromatography test for fecal calprotectin

“…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 .…”

“…2,3 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). [4][5][6] 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. 3 Thus, noninvasive method for monitoring disease activity is preferable.…”