Review article: faecal calprotectin and histologic remission in ulcerative colitis

Abstract

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.

Paradoxical gastrointestinal effects of interleukin-17 blockers

“…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. In case of confirmed active IBD, anti-IL-17 drugs should be contraindicated, whereas in patients with quiescent IBD, alternative treatments should be preferred.…”

Patient knowledge of fecal calprotectin in inflammatory bowel disease (IBD): An observational study in Mexico

“…The test's response to medical treatment correlates with mucosal scarring or endoscopic remission, and is a good predictor of relapse, so access should be easily available in any medical unit 24 . Furthermore, expert guidelines suggest that disease activity should be reassessed every 3 to 6 months 25 , therefore, it would be important for public and private medical units to have the FC test for regular cost-effective testing 17,26 .…”

Dynamic Evaluation of Compound Ento-PB&nbsp;for the Repair of Mucosal Ulcer in Dogs With Acetic Acid-induced Experimental Colitis&nbsp;

“…Acetic acid-induced colitis can cause severe in ammation of colon and rapid formation of ulcer, and be accompanied by diarrhea, hematochezia, and weight loss, which is similar to the situation of acute ulcerative colon in ammation that caused by abnormal arachidonic acid metabolism in human colitis [22,23]. Mucosal ulcer is an early event in the occurrence mechanism of UC, and repair after mucosal injury is used as an important index to evaluate the e cacy of drugs [24]. Colonoscopy is currently an important method to clinically evaluate the healing of intestinal mucosal injury after the treatment of UC patients [25,26].…”