- Email: [email protected]
Is fecal calprotectin useful for monitoring endoscopic disease activity in patients with postoperative Crohn's disease?
Journal of Crohn's and Colitis (2013) 7, e712
Available online at www.sciencedirect.com
ScienceDirect
LETTER TO THE EDITOR Is fecal calprotectin useful for monitoring endoscopic disease activity in patients with postoperative Crohn's disease?
Dear Sir,
We read with interest the article by Lobatón et al., ‘A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn's disease (CD)’.1 Fecal calprotectin levels were determined by an enzyme-linked immunoassay test (FC-ELISA) and a new quantitative point-ofcare test (FC-QPOCT) in patients after surgery for CD. Endoscopic activity was evaluated according to the CD Endoscopic Index of Severity (CDEIS) and the Rutgeerts score.2 Fecal calprotectin levels correlated closely with the CDEIS. FCQPOCT (cut-off 272 μg/g) and FC-ELISA (cut-off 274 μg/g) were useful for the prediction of endoscopic remission (CDEIS b 3) with high accuracy. FC-QPOCT results correlated with endoscopic activity. Median FC-QPOCT levels discriminated Rutgeerts score i0–i1 from i2–i4 (98 μg/g vs. 234.5 μg/g, respectively). These results suggest that fecal calprotectin levels determined by rapid quantitative test can predict endoscopic activity after surgery for CD. Several studies reported that fecal calprotectin and lactoferrin showed a close correlation with endoscopic inflammation in patients with inflammatory bowel disease3,4. However, the clinical significance of these markers in postoperative CD was not fully evaluated. Recently, we conducted a prospective study to investigate the relationship between endoscopic activity and fecal markers, and assess the predictive value of these markers for future recurrence.5 Twenty patients who remained in remission during 6–12 months after ileocolic resection were studied. All patients underwent ileocolonoscopy for assessing endoscopic activity (Rutgeerts score) in the neo-terminal ileum. Fecal calprotectin was measured by a quantitative enzyme immunoassay. Lactoferrin was measured by a colloidal gold agglutination reagent using a highthroughput discrete clinical chemistry analyzer. All patients were then followed up for 12 months, and clinical recurrence was defined as the CD activity index (CDAI) N 150 with an increase of ≥70 points. Both calprotectin and lactoferrin positively correlated with the endoscopic scores. Six patients (30%) developed clinical recurrence during the 12-month follow-up. Both calprotectin and lactoferrin levels were significantly higher in patients with clinical recurrence than those in remission. A cutoff value of 170 μg/g for calprotectin
had a sensitivity of 83% and a specificity of 93% to predict a risk of clinical recurrence, while a cutoff value of 140 μg/g for lactoferrin had a sensitivity of 67% and a specificity of 71%. Based on the findings of these studies,1,5 fecal calprotectin and lactoferrin levels correlate well with endoscopic activity after resection for CD. Furthermore, calprotectin and lactoferrin are useful biomarkers for predicting postoperative recurrence. Assays of fecal calprotectin and lactoferrin should serve as low cost, and non-invasive biomarkers to monitor disease activity and predict postoperative recurrence. We hope that this should spare the patients from going through complicated colonoscopy procedures.
Conflict of interest None declared.
References 1. Lobatón T, López-García A, Rodríguez-Moranta F, Ruiz A, Rodríguez L, Guardiola J. A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn's disease. J Crohns Colitis 2013;7:e641–51. 2. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990;99:956–63. 3. Sipponen T, Kärkkäinen P, Savilahti E, Kolho KL, Nuutinen H, Turunen U, et al. Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn's disease and histological findings. Aliment Pharmacol Ther 2008;28:1221–9. 4. Jones J, Loftus Jr EV, Panaccione R, Chen LS, Peterson S, McConnell J, et al. Relationships between disease activity and serum and fecal biomarkers in patients with Crohn's disease. Clin Gastroenterol Hepatol 2008;6:1218–24. 5. Yamamoto T, Bamba T, Umegae S, Matsumoto K. The impact of early endoscopic lesions on the clinical course of patients following ileocolonic resection for Crohn's disease: a 5-year prospective cohort study. U Eur Gastroenterol J 2013 [Epub ahead of print]. Takayuki Yamamoto Inflammatory Bowel Disease Centre, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan Corresponding author. Tel.: + 81 59 331 2000; fax: +81 59 331 0354. E-mail address: [email protected]. Paulo Gustavo Kotze Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Parana, Curitiba, PR, Brazil
11 August 2013
1873-9946/$ - see front matter © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.crohns.2013.08.005
Available online at www.sciencedirect.com
ScienceDirect
LETTER TO THE EDITOR Is fecal calprotectin useful for monitoring endoscopic disease activity in patients with postoperative Crohn's disease?
Dear Sir,
We read with interest the article by Lobatón et al., ‘A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn's disease (CD)’.1 Fecal calprotectin levels were determined by an enzyme-linked immunoassay test (FC-ELISA) and a new quantitative point-ofcare test (FC-QPOCT) in patients after surgery for CD. Endoscopic activity was evaluated according to the CD Endoscopic Index of Severity (CDEIS) and the Rutgeerts score.2 Fecal calprotectin levels correlated closely with the CDEIS. FCQPOCT (cut-off 272 μg/g) and FC-ELISA (cut-off 274 μg/g) were useful for the prediction of endoscopic remission (CDEIS b 3) with high accuracy. FC-QPOCT results correlated with endoscopic activity. Median FC-QPOCT levels discriminated Rutgeerts score i0–i1 from i2–i4 (98 μg/g vs. 234.5 μg/g, respectively). These results suggest that fecal calprotectin levels determined by rapid quantitative test can predict endoscopic activity after surgery for CD. Several studies reported that fecal calprotectin and lactoferrin showed a close correlation with endoscopic inflammation in patients with inflammatory bowel disease3,4. However, the clinical significance of these markers in postoperative CD was not fully evaluated. Recently, we conducted a prospective study to investigate the relationship between endoscopic activity and fecal markers, and assess the predictive value of these markers for future recurrence.5 Twenty patients who remained in remission during 6–12 months after ileocolic resection were studied. All patients underwent ileocolonoscopy for assessing endoscopic activity (Rutgeerts score) in the neo-terminal ileum. Fecal calprotectin was measured by a quantitative enzyme immunoassay. Lactoferrin was measured by a colloidal gold agglutination reagent using a highthroughput discrete clinical chemistry analyzer. All patients were then followed up for 12 months, and clinical recurrence was defined as the CD activity index (CDAI) N 150 with an increase of ≥70 points. Both calprotectin and lactoferrin positively correlated with the endoscopic scores. Six patients (30%) developed clinical recurrence during the 12-month follow-up. Both calprotectin and lactoferrin levels were significantly higher in patients with clinical recurrence than those in remission. A cutoff value of 170 μg/g for calprotectin
had a sensitivity of 83% and a specificity of 93% to predict a risk of clinical recurrence, while a cutoff value of 140 μg/g for lactoferrin had a sensitivity of 67% and a specificity of 71%. Based on the findings of these studies,1,5 fecal calprotectin and lactoferrin levels correlate well with endoscopic activity after resection for CD. Furthermore, calprotectin and lactoferrin are useful biomarkers for predicting postoperative recurrence. Assays of fecal calprotectin and lactoferrin should serve as low cost, and non-invasive biomarkers to monitor disease activity and predict postoperative recurrence. We hope that this should spare the patients from going through complicated colonoscopy procedures.
Conflict of interest None declared.
References 1. Lobatón T, López-García A, Rodríguez-Moranta F, Ruiz A, Rodríguez L, Guardiola J. A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn's disease. J Crohns Colitis 2013;7:e641–51. 2. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990;99:956–63. 3. Sipponen T, Kärkkäinen P, Savilahti E, Kolho KL, Nuutinen H, Turunen U, et al. Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn's disease and histological findings. Aliment Pharmacol Ther 2008;28:1221–9. 4. Jones J, Loftus Jr EV, Panaccione R, Chen LS, Peterson S, McConnell J, et al. Relationships between disease activity and serum and fecal biomarkers in patients with Crohn's disease. Clin Gastroenterol Hepatol 2008;6:1218–24. 5. Yamamoto T, Bamba T, Umegae S, Matsumoto K. The impact of early endoscopic lesions on the clinical course of patients following ileocolonic resection for Crohn's disease: a 5-year prospective cohort study. U Eur Gastroenterol J 2013 [Epub ahead of print]. Takayuki Yamamoto Inflammatory Bowel Disease Centre, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan Corresponding author. Tel.: + 81 59 331 2000; fax: +81 59 331 0354. E-mail address: [email protected]. Paulo Gustavo Kotze Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Parana, Curitiba, PR, Brazil
11 August 2013
1873-9946/$ - see front matter © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.crohns.2013.08.005