Fecal calprotectin in pediatric gastrointestinal diseases: Pros and cons

Evaluation of fecal neutrophil gelatinase-associated lipocalin levels in childhood inflammatory bowel disease

OBJECTIVES

Inflammatory bowel disease (IBD) is an immune-mediated, chronic, remitting, and relapsing disease. Calprotectin, used in monitoring the disease activity, is expressed from neutrophilic granulocytes during inflammation. Neutrophil gelatinase-associated lipocalin (NGAL) is strongly expressed in both granulocytes and the intestinal epithelial cell layer. The aim of the study was to compare fecal NGAL (FNGAL) with fecal calprotectin (FCAL) in children with IBD.

METHODS

Forty-four children with IBD and 22 healthy children were included in the study. The patients were divided into two groups, patients with active disease and remission group. Clinical and demographic characteristics, disease activity scores, and serum and fecal markers of the patients were recorded.

RESULTS

The mean age of the patients was 13.2 ± 3.4 years (range 6-17 years) and male/female: 0.62. FNGAL levels of patients with active disease were higher than those in the remission group (p < 0.001). A statistically significant positive correlation was observed between Pediatric Ulcerative Colitis Activity Index scores and white blood cell count, platelets, neutrophil-to-albumin ratio (NAR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and FNGAL. There was a positive correlation between Pediatric Crohn's Disease Activity Index scores and platelets, NAR, ESR, CRP, and FNGAL, whereas there was a statistically significantly negative correlation with activity scores and albumin. While FNGAL had 95.5% sensitivity and 81.8% specificity, FCAL had 86.7% sensitivity and 85.7% specificity.

CONCLUSIONS

FNGAL levels were found to be high and sensitive in determining disease activity in our patients with IBD, suggesting that it may be a valuable biomarker.

Utility of fecal calprotectin in the diagnosis of inflammatory bowel diseases

Introduction: Inflammatory bowel disease involves two main disorders: Crohn's disease and ulcerative colitis. Colonoscopy with biopsy is considered the gold standard for the diagnosis of IBD, although these are invasive and costly techniques. In recent years, fecal calprotectin has gained relevance as a non-invasive biomarker with significant clinical utility. The effectiveness of fecal calprotectin has been demonstrated in distinguishing between IBD and irritable bowel syndrome, predicting endoscopic and histological activity, as well as disease recurrence.Objective: Review the current literature on the clinical utility of fecal calprotectin in the diagnosis and management of inflammatory bowel diseases.Methods: Systematic review based on the PRISMA method, of studies obtained through searches in Scopus, PubMed, Virtual Health Library, Web of Science, Latindex, and Google Scholar. Primary and secondary studies published in the last five years in English and Spanish were included.Results: Nineteen studies were analyzed, describing high sensitivity and specificity in distinguishing IBD from IBS, helping to reduce the rate of unnecessary colonoscopies in patients with non-specific gastrointestinal symptoms. Additionally, fecal calprotectin was found to significantly correlate with endoscopic and histological activity.Conclusions: Fecal calprotectin is a reliable biomarker of mucosal inflammation, capable of identifying patients with a higher likelihood of having IBD, allowing for better management of colonoscopy resources and reducing associated costs.