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Gaikwad U, Bhargava A, Jindal A, Padhy GK, Das P, Jagzape T, Lalwani A, Dash D. Faecal calprotectin as an inflammatory biomarker to distinguish between bacterial and viral causes of childhood diarrhoea in Indian settings. Indian J Med Microbiol 2023; 46:100459. [PMID: 37945132 DOI: 10.1016/j.ijmmb.2023.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/19/2023] [Accepted: 08/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the value of faecal calprotectin (f-CP) in distinguishing between bacterial and viral aetiologies of infective diarrhoea in children attending a tertiary care hospital in Central India. METHODS Stool samples from children aged 3 months to 10 years who had acute or persistent diarrhoea were processed for microscopy, bacterial culture, and viral antigen detection (Rotavirus and Norovirus). The remaining samples, as well as stool samples from 20 healthy controls, were tested for f-CP using the enzyme linked immunosorbent assay. RESULTS Among 48 patients, 21 (43.7%) had bacterial diarrhoea, 14 (29.2%) had viral diarrhoea, and 13 (27.1%) had an unidentified aetiology. The median f-CP values were significantly (p = 0.004) higher in children with bacterial diarrhoea (75.2 μg/g; IQR-18.75-239.15) than in children with viral diarrhoea (75.2 μg/g; IQR-123.5-1987.5). Bacterial aetiology could be reliably predicted at the optimum f-CP concentrations of >541 μg/g and >238.4 μg/g in children aged 1 and 1-4 years, with an area under the curve of 0.767 and 0.867, respectively, using receiver-operator characteristic analysis. CONCLUSIONS Faecal calprotectin could reliably distinguish between bacterial and viral aetiologies of diarrhoea in children aged up to four years, but at relatively higher age-specified cut off values.
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Affiliation(s)
- Ujjwala Gaikwad
- Department of Microbiology, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India.
| | - Anudita Bhargava
- Department of Microbiology, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India.
| | - Atul Jindal
- Department of Paediatrics, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099 , India.
| | - Gouri Kumari Padhy
- Department of Community and Family Medicine, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India.
| | - Padma Das
- Department of Microbiology, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India.
| | - Tushar Jagzape
- Department of Paediatrics, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099 , India.
| | - Akash Lalwani
- Department of Pediatrics and Neonatology Pt. Jawahar Lal Nehru Memorial Medical College, Jail Road, Raipur, 492001, India.
| | - Debabrata Dash
- Department of Microbiology, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India.
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Piñero G, Mañosa M, Calafat M, Vayreda E, Cañete F, Puig M, Domènech E. Mesalazine dose modification based on faecal calprotectin levels in patients with ulcerative colitis in clinical remission. Gastroenterol Hepatol 2023:S0210-5705(23)00439-9. [PMID: 37806344 DOI: 10.1016/j.gastrohep.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Faecal calprotectin (FC) shows an excellent correlation with endoscopic and histological activity of ulcerative colitis (UC) and it is the best predictor of clinical relapse. Our aim was to evaluate the usefulness of modifying the dose of mesalazine based on FC levels, in clinical practice. METHODS Retrospective, single-centre study in UC patients in clinical remission while treated with mesalazine which dosage was decreased (DOWN) or increased (UP) according to FC levels. The main endpoint was the long-term maintenance of clinical remission. RESULTS A total of 56 patients were included (39 DOWN, 17 UP). In the DOWN group, the median baseline dose of mesalazine was 3.6g/day and the median baseline FC was 36μg/g. After a median follow-up of 22 months, 28% required rescue therapy. The cumulative relapse-free survival after tapering was 91% and 82% at 12 and 24 months, respectively. In the UP group, the median baseline dose of mesalazine was 2.4g/day, with a median baseline FC of 524μg/g. After a median follow-up of 12 months, 29% required rescue therapy. The cumulative relapse-free survival after dose increase was 86% and 72% at 12 and 24 months, respectively. CONCLUSIONS Mesalazine dose modification based on FC monitoring seems to be a safe strategy in patients with UC in clinical remission, with a probability of clinical relapse around 20% at two years.
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Affiliation(s)
- Gisela Piñero
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España; Servicio de Gastroenterología, Hospital Provincial del Centenario, Rosario, Argentina
| | - Míriam Mañosa
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Margalida Calafat
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Eva Vayreda
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Fiorella Cañete
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Maria Puig
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Eugeni Domènech
- Servicio de Aparato Digestivo, Hospital Univrsitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
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D’Haens G, Safroneeva E, Thorne H, Laoun R. Assessing the Clinical and Endoscopic Efficacy of Extended Treatment Duration with Different Doses of Mesalazine for Mild-to-Moderate Ulcerative Colitis beyond 8 Weeks of Induction. Inflamm Intest Dis 2023; 8:51-59. [PMID: 37901343 PMCID: PMC10601940 DOI: 10.1159/000531372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction High-strength mesalazine formulations play an important role in providing a convenient option to increase the dose in ulcerative colitis (UC) patients and therefore avoiding the switch to another therapeutic class. Higher doses of mesalazine may be required during periods of remission in order to prevent relapse. Aim The aim of the study was to investigate clinical outcomes of three mesalazine maintenance doses adapted for post induction response. Methods In this post hoc analysis, 675 UC patients entered an open-label extension study for a total of 38 weeks (including 8-12 week induction period with 3.2 g/day mesalazine). After the induction period, they were separated into three groups: remitters (in clinical and endoscopic remission), responders (decrease in Partial Mayo Clinic Score of ≥2 points and ≥30% from week 0), and nonresponders (failed to achieve endoscopic or clinical response at week 8) and received 1.6 g/day, 3.2 g/day, or 4.8 g/day of mesalazine (using a new 1,600 mg mesalazine tablet), respectively. Results 133/202 (65.8%), 108/274 (39.4%), and 59/199 (29.6%) patients achieved clinical and endoscopic remission at week 38 with 1.6 g/day, 3.2 g/day, and 4.8 g/day, respectively. At week 38, 142/202 (70.3%), 93/274 (33.9%), and 61/199 (30.7%) patients achieved clinical remission (stool score of 0 and rectal bleeding score of 0) with 1.6 g/day, 3.2 g/day, and 4.8 g/day, respectively. Conclusions Patients partially responding or not responding to an initial induction dose of 3.2 g/day mesalazine could benefit from an extended treatment period at the same dose, or an increase to 4.8 g/day in an attempt to achieve combined clinical and endoscopic remission.
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Affiliation(s)
- Geert D’Haens
- Inflammatory Bowel Disease Centre, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Helen Thorne
- Medical Affairs, Tillotts Pharma AG, Rheinfelden, Switzerland
| | - Raphaël Laoun
- Medical Affairs, Tillotts Pharma AG, Rheinfelden, Switzerland
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Gutiérrez-Díaz I, Sanz-Martinez M, Castro AM, Rodríguez-Belvís MV, Carreira N, Jiménez S, Mangas C, Queralt M, Herrador M, Martín-Masot R, Ferrer P, Navas-López VM, Espín B, Leis R, Díaz JJ, Delgado S. Microbial and immune faecal determinants in infants hospitalized with COVID-19 reflect bifidobacterial dysbiosis and immature intestinal immunity. Eur J Pediatr 2023; 182:4633-4645. [PMID: 37555973 PMCID: PMC10587250 DOI: 10.1007/s00431-023-05140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly worldwide, seriously endangering human health. Although SARS-CoV-2 had a lower impact on paediatric population, children with COVID-19 have been reported as suffering from gastrointestinal (GI) symptoms at a higher rate than adults. The aim of this work was to evaluate faeces as a source of potential biomarkers of severity in the paediatric population, with an emphasis on intestinal microbiota and faecal immune mediators, trying to identify possible dysbiosis and immune intestinal dysfunction associated with the risk of hospitalization. This study involved 19 patients with COVID-19 under 24 months of age hospitalized during the pandemic at 6 different hospitals in Spain, and it included a comparable age-matched healthy control group (n = 18). Patients and controls were stratified according to their age in two groups: newborns or young infants (from 0 to 3 months old) and toddlers (infants from 6 to 24 months old). To characterize microbial intestinal communities, sequencing with Illumina technology of total 16S rDNA amplicons and internal transcribed spacer (ITS) amplicons of bifidobacteria were used. Faecal calprotectin (FC) and a range of human cytokines, chemokines, and growth factors were measured in faecal samples using ELISA and a multiplex system. Significant reduction in the abundance of sequences belonging to the phylum Actinobacteria was found in those infants with COVID-19, as well as in the Bifidobacteriaceae family. A different pattern of bifidobacteria was observed in patients, mainly represented by lower percentages of Bifidobacterium breve, as compared with controls. In the group of hospitalized young infants, FC was almost absent compared to age-matched healthy controls. A lower prevalence in faecal excretion of immune factors in these infected patients was also observed. CONCLUSION Hospitalized infants with COVID-19 were depleted in some gut bacteria, such as bifidobacteria, in particular Bifidobacterium breve, which is crucial for the proper establishment of a functional intestinal microbiota, and important for the development of a competent immune system. Our results point to a possible immature immune system at intestine level in young infants infected by SARS-CoV2 requiring hospitalization. WHAT IS KNOWN • Although SARS-CoV-2 had a lower impact on paediatric population, children with COVID-19 have been reported as suffering from gastrointestinal symptoms at a higher rate than adults. • Changes in microbial composition have been described in COVID-19 adult patients, although studies in children are limited. WHAT IS NEW • The first evidence that hospitalized infants with COVID-19 during the pandemic had a depletion in bifidobacteria, particularly in Bifidobacterium breve, beneficial gut bacteria in infancy that are crucial for the proper establishment of a competent immune system. • In young infants (under 3 months of age) hospitalized with SARS-CoV2 infection, the aberrant bifidobacterial profile appears to overlap with a poor intestinal immune development as seen by calprotectin and the trend of immunological factors excreted in faeces.
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Affiliation(s)
- Isabel Gutiérrez-Díaz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas (CSIC), Villaviciosa, Asturias, Spain.
- MicroHealth Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain.
| | - Miriam Sanz-Martinez
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas (CSIC), Villaviciosa, Asturias, Spain
| | - Ana Mª Castro
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas (CSIC), Villaviciosa, Asturias, Spain
- MicroHealth Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | | | - Nathalie Carreira
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- Paediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS). CHUS-USC, Santiago de Compostela, Spain
| | - Santiago Jiménez
- Paediatric Gastroenterology and Nutrition Section, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Carmen Mangas
- Paediatrics, Primary Care Center "Otero," Oviedo, Asturias, Spain
| | - Macarena Queralt
- Paediatric Gastroenterology Unit, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Andalucia, Spain
| | - Marta Herrador
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Andalucia, Spain
| | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Andalucia, Spain
| | - Pablo Ferrer
- Paediatric Service, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Comunidad Valenciana, Spain
| | - Víctor M Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Andalucia, Spain
| | - Beatriz Espín
- Paediatric Gastroenterology Unit, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Andalucia, Spain
| | - Rosaura Leis
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- Paediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS). CHUS-USC, Santiago de Compostela, Spain
| | - Juan J Díaz
- Paediatric Gastroenterology and Nutrition Section, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain.
| | - Susana Delgado
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas (CSIC), Villaviciosa, Asturias, Spain
- MicroHealth Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
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Kozlov KV, Zhdanov KV, Ratnikova AK, Ratnikov VA, Tishkov AV, Grinevich V, Kravchuk YA, Miklush PI, Nikiforova PO, Gordienko VV, Popov AF, Andryukov BG. Hepatobiliary system and intestinal injury in new coronavirus infection (COVID-19): A retrospective study. World J Clin Cases 2023; 11:2226-2236. [PMID: 37122523 PMCID: PMC10131012 DOI: 10.12998/wjcc.v11.i10.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/22/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND An important area of effective control of the coronavirus disease 19 (COVID-19) pandemic is the study of the pathogenic features of severe acute respiratory syndrome coronavirus 2 infection, including those based on assessing the state of the intestinal microbiota and permeability.
AIM To study the clinical features of the new COVID-19 in patients with mild and moderate severity at the stage of hospitalization, to determine the role of hepatobiliary injury, intestinal permeability disorders, and changes in the qualitative and quantitative composition of the microbiota in the development of systemic inflammation in patients with COVID-19.
METHODS The study was performed in 80 patients with COVID-19, with an average age of 45 years, 19 of whom had mild disease, and 61 had moderate disease severity. The scope of the examination included traditional clinical, laboratory, biochemical, instrumental, and radiation studies, as well as original methods for studying microbiota and intestinal permeability.
RESULTS The clinical course of COVID-19 was studied, and the clinical and biochemical features, manifestations of systemic inflammation, and intestinal microbiome changes in patients with mild and moderate severity were identified. Intestinal permeability characteristics against the background of COVID-19 were evaluated by measuring levels of proinflammatory cytokines, insulin, faecal calprotectin, and zonulin.
CONCLUSION This study highlights the role of intestinal permeability and microbiota as the main drivers of gastroenterological manifestations and increased COVID-19 severity.
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Affiliation(s)
- Konstantin V Kozlov
- Department of Infectious Disease, Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Konstantin V Zhdanov
- Department of Infectious Disease, Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Anna K Ratnikova
- Department of Admission, Federal State Budgetary Institution "North-West District Scientific and Clinical Center Named After LG. Sokolov Federal Medical and Biological Agency", Saint-Petersburg 194291, Russia
| | - Vyacheslav A Ratnikov
- Department of Roentgenology, Federal State Budgetary Institution "North-West District Scientific and Clinical Center Named After LG. Sokolov Federal Medical and Biological Agency", Saint-Petersburg 194291, Russia
| | - Artem V Tishkov
- Department of Physics, Mathematics and Informatics, FSBEI HE IP. Pavlov SPbSMU MOH Russia, Saint-Petersburg 197022, Russia
| | - Vladimir Grinevich
- 2nd Department of Therapy (Advanced Medical Education), Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Yuriy A Kravchuk
- Department of Infectious Disease, Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Panteley I Miklush
- Department of Infectious Disease, Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Polina O Nikiforova
- Department of Infectious Disease, Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Vera V Gordienko
- Department of Infectious Disease, Military Medical Academy Named After SM. Kirov, Saint-Petersburg 194044, Russia
| | - Alexander F Popov
- School of Medicine, Far Eastern Federal University, Vladivostok 690922, Russia
| | - Boris G Andryukov
- School of Medicine, Far Eastern Federal University, Vladivostok 690922, Russia
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Grgić D, Golubić K, Brinar M, Krznarić Ž. Predictive value of faecal calprotectin in ulcerative colitis - single centre experience. Ann Med 2022; 54:1570-1577. [PMID: 35635011 PMCID: PMC9891222 DOI: 10.1080/07853890.2022.2082518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings. METHODS The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0-1: remission, and MES 2-3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression. RESULTS According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914-0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085-0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g. CONCLUSION Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGESFaecal calprotectin is an independent predictor of remission in UC patients.Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn't been evaluated yet.We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.
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Affiliation(s)
- Dora Grgić
- Department of Gastroenterology and Hepatology, Division of Internal medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Karlo Golubić
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - Marko Brinar
- Department of Gastroenterology and Hepatology, Division of Internal medicine, University Hospital Center Zagreb, Zagreb, Croatia.,School of medicine, University of Zagreb, Zagreb, Croatia
| | - Željko Krznarić
- Department of Gastroenterology and Hepatology, Division of Internal medicine, University Hospital Center Zagreb, Zagreb, Croatia.,School of medicine, University of Zagreb, Zagreb, Croatia
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7
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Helwig U, Krause TH, Maaser C, Büning J, Drabik A, Blömacher M, Plachta-Danielzik S, Teich N, Krummenerl A, Sturm A, Schwab M, Schreiber S. Early MOnitoring of REsponse (MORE) to Golimumab Therapy: Results of a Multicentre, Prospective Observational Trial. Dig Dis 2022; 41:239-249. [PMID: 36323226 DOI: 10.1159/000527460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The therapeutic goal of clinical remission in patients with moderate to severe ulcerative colitis (UC) is achieved after biological therapy only in 16-39%. Individualization of therapeutic intervention would benefit from prediction of early response. STUDY OBJECTIVE The primary objective of our study was to assess golimumab (GLM) trough serum level of ≥2.5 μg/mL in combination with a reduction of faecal calprotectin (FC) of ≥50% at week 6 compared to baseline to predict clinical response at week 26 after regular GLM intake. METHODS Patients with moderate to severe active UC and planned GLM treatment were recruited for a prospective, multicentre, observational study in Germany. Prediction of clinical response was assessed by FC and GLM trough level. Missing data were imputed as therapy failure according to the last observation carried forward method. RESULTS Fifty nine patients have been enrolled. 54% of patients were anti-TNF naïve. Clinical response at week 6 was a significant predictor for achieving clinical response at week 26 (odds ratio [OR] 10.97, confidence interval [CI], 2.96-40.68; p < 0.001). Moreover, patients with a GLM trough level of ≥2.5 μg/mL and a ≥50% reduction of FC at week 6 had an OR of 5.33 (95% CI, 0.59-47.84) to achieve clinical response at week 26. CONCLUSION Clinical response at week 6 is the best predictive marker for achieving clinical response at week 26. Consideration of significant reduction of FC and trough GLM serum levels could improve prediction of response.
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Affiliation(s)
- Ulf Helwig
- Internistische Praxengemeinschaft Oldenburg, Oldenburg, Germany.,Christian-Albrechts-Universität zu Kiel, UKSH Campus Kiel, Kiel, Germany
| | | | | | | | | | | | | | - Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselerkrankungen, Leipzig, Germany
| | | | | | - Matthias Schwab
- Institut für Klinische Pharmakologie, Stuttgart, Germany.,Department für Experimentelle und Klinische Pharmakologie und Pharmakogenomik, Universität Tübingen, Tübingen, Germany
| | - Stefan Schreiber
- Christian-Albrechts-Universität zu Kiel, UKSH Campus Kiel, Kiel, Germany
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O'Moráin N, Stack R, Doherty J, Tosetto M, Garcia Leon A, Mallon P, Doherty G. Faecal calprotectin as a potential biomarker of disease severity in SARS-CoV-2 infection. J Infect 2022; 85:436-480. [PMID: 35768051 PMCID: PMC9233623 DOI: 10.1016/j.jinf.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/05/2022]
Affiliation(s)
- N O'Moráin
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland.
| | - R Stack
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - J Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - M Tosetto
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Garcia Leon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, 4, Ireland
| | - P Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, 4, Ireland; Department of Infectious Disease, St. Vincent's University Hospital, Dublin, 4, Ireland
| | - G Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland
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Daoud ND, Hashash JG, Picco MF, Farraye FA. Faecal Calprotectin from Ileostomy Output Is Sensitive and Specific for the Prediction of Small Bowel Inflammation in Patients with Crohn's Disease. J Crohns Colitis 2022; 16:601-605. [PMID: 34633435 DOI: 10.1093/ecco-jcc/jjab182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Severe Crohn's disease [CD] can result in extensive bowel resections and need for creation of an ileostomy. Faecal calprotectin [FC] is well studied in CD management, though its role in patients who have an ileostomy is unclear. Our aim is to understand if FC is a useful adjunct to radiographic or endoscopic studies in identifying recurrent CD after surgery in patients with an ileostomy. METHODS Between January 1, 2017, and September 30, 2020, we searched the Mayo Clinic electronic medical record retrospectively for adult patients with ICD-10 code for CD, and a surgical history of an ileostomy. Patients were included in the analysis if they had at least one FC measured and a concomitant radiographic imaging and/or endoscopic procedure. An abnormal FC was defined as greater than 60 µg/g. RESULTS Of 51 patients who met our inclusion criteria, 17 had an FC level >60 µg/g. Of these 17 patients, 14 had imaging and/or an ileoscopy confirming the presence of small bowel inflammation, with a sensitivity of 87.5%. Of the remaining 34 patients with an FC level ≤60 µg/g, 32 patients had imaging and/or ileoscopy demonstrating no small bowel inflammation, with a specificity of 91.4%. FC from an ileostomy effluent had a positive predictive value of 82.3%, a negative predictive value of 94.1% and test diagnostic accuracy of 90.1%. CONCLUSION FC from an ileostomy effluent is a highly sensitive and specific test for the assessment and monitoring of small bowel inflammation and disease recurrence in patients with CD.
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Affiliation(s)
- Nader D Daoud
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Michael F Picco
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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10
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Abstract
Colonoscopy is currently the gold standard for diagnosis of inflammatory bowel disease (IBD) and colorectal cancer (CRC). This has the obvious drawback of being invasive as well as carrying a small risk. The most widely used non-invasive approaches include the use of faecal calprotectin in the case of IBD and fecal immunochemical test in the case of CRC. However, the necessity of stool collection limits their acceptability for some patients. Over the recent years, there has been emerging data looking at the role of non-invasively obtained colorectal mucus as a screening and diagnostic tool in IBD and CRC. It has been shown that the mucus rich material obtained by self-sampling of anal surface following defecation, can be used to measure various biomarkers that can aid in diagnosis of these conditions.
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Affiliation(s)
| | - Andrew Poullis
- Department of Gastroenterology, St George's Hospital, London SW17 0QT, United Kingdom
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11
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Emad Y, Ragab Y, Hammam N, El-Shaarawy N, Fawzi M, Amer A, El-Makhzangy H, Ismail A, Ibrahim O, Hassan Y, Kamal A, Rasker JJ. The clinical utility of faecal calprotectin in patients with differentiated and undifferentiated spondyloarthritis: Relevance and clinical implications. Reumatol Clin (Engl Ed) 2022; 18:69-76. [PMID: 35153039 DOI: 10.1016/j.reumae.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/22/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. MATERIAL AND METHODS A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. RESULTS The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). CONCLUSIONS Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, AssiutUniversity, Assiut, Egypt; Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Magdy Fawzi
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Arwa Amer
- Rheumatology, Rehabilitation and Physical MedicineDepartment, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hesham El-Makhzangy
- Tropical Medicines Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ismail
- Dermatology Department, Faculty of Medicine, Al-Azhar University Cairo, Egypt
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, UK
| | - Yosra Hassan
- Clinical pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Kamal
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioural, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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12
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Jose SK, Simon B, Simon EG, Eapen A, John RA, Putta T, Dutta AK, Pulimood AB. Comparison of Magnetic Resonance Enterography Global Score (MEGS) with indices of Crohn's disease activity in South Asian population. Abdom Radiol (NY) 2022; 47:547-53. [PMID: 34958408 DOI: 10.1007/s00261-021-03381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Assessment of disease activity in Crohn's helps predict important clinical outcomes. Among the various modalities available to assess disease activity, magnetic resonance enterography (MRE) is considered a safe and reliable imaging option. Various MRE-based scoring systems have been developed to measure disease activity, one of which being the MRE global score (MEGS). We aimed to correlate MEGS with some of the important indices of Crohn's disease activity. METHODOLOGY Crohn's disease patients referred for MRE were included in the study. Along with demographic profile and relevant investigations, MRE parameters related to MEGS were also assessed. RESULT A total of 47 patients were recruited for the study. Their median age was 34 years (range 18-68 years), and male:female ratio was 16:31. There was modest positive correlation between MEGS and faecal calprotectin (r = 0.3, p = 0.04), CRP level (r = 0.34, p = 0.02) and Harvey Bradshaw index (r = 0.3, p = 0.043), respectively. However, there was strong correlation between segmental MEGS and Simple Endoscopic Score in those with terminal ileal disease (r = 0.81, p < 0.001). Mural thickness was the only MRE parameter that correlated with active disease (OR - 1.35, 95% CI 1.01, 1.81, p = 0.041) on multivariate analysis. There was moderate inter-observer agreement (Lin's r = 0.78, p < 0.001). CONCLUSION MEGS showed modest correlation with indices of Crohn's disease activity which corroborates the complementary role of MRE in management of such patients.
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13
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Gkikas K, Logan M, Nichols B, Ijaz UZ, Clark CM, Svolos V, Gervais L, Duncan H, Garrick V, Curtis L, Buchanan E, Cardigan T, Armstrong L, Delahunty C, Flynn DM, Barclay AR, Tayler R, Milling S, Hansen R, Russell RK, Gerasimidis K. Dietary triggers of gut inflammation following exclusive enteral nutrition in children with Crohn's disease: a pilot study. BMC Gastroenterol 2021; 21:454. [PMID: 34861829 PMCID: PMC8642954 DOI: 10.1186/s12876-021-02029-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background The anti-inflammatory effect of exclusive enteral nutrition on the gut of children with Crohn’s disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition. Methods Nutrient intake, dietary patterns and dietary biomarkers in faeces (gluten immunogenic peptides, undigestible starch, short chain fatty acids) were assessed in 14 children with Crohn’s disease during early food reintroduction, following exclusive enteral nutrition. Groups above (Group A) and below (Group B) the median levels of faecal calprotectin after food reintroduction were assigned for comparative analysis. Results Intakes of fibre, gluten-containing cereals and red and processed meat were significantly higher in Group A than Group B; (median [Q1, Q3], g/day; Fibre: 12.1 [11.2, 19.9] vs. 9.9 [7.6, 12.1], p = 0.03; Red and processed meat: 151 [66.7, 190] vs. 63.3 [21.7, 67], p = 0.02; gluten-containing cereals: 289 [207, 402] vs. 203 [61, 232], p = 0.035). A diet consisting of cereals and meat products was predictive (92% accuracy) of higher faecal calprotectin levels after food reintroduction. In faeces, butyrate levels, expressed as absolute concentration and relative abundance, were higher in Group A than Group B by 28.4 µmol/g (p = 0.015) and 6.4% (p = 0.008), respectively. Levels of gluten immunogenic peptide and starch in faeces did not differ between the two groups. Conclusions This pilot study identified potential dietary triggers of gut inflammation in children with Crohn’s disease after food reintroduction following treatment with exclusive enteral nutrition. Trial registration: Clinical trials.gov registration number: NCT02341248; Clinical trials.gov URL: https://clinicaltrials.gov/ct2/show/NCT02341248 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-02029-4.
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Affiliation(s)
- Konstantinos Gkikas
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Michael Logan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ben Nichols
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Umer Z Ijaz
- Civil Engineering, School of Engineering, University of Glasgow, Glasgow, UK
| | - Clare M Clark
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Vaios Svolos
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Lisa Gervais
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Hazel Duncan
- Department of Paediatrics, Crosshouse Hospital, Kilmarnock, UK
| | - Vikki Garrick
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Lee Curtis
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Elaine Buchanan
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Tracey Cardigan
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | | | | | - Diana M Flynn
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Andrew R Barclay
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Rachel Tayler
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Simon Milling
- Institute for Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | | | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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14
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Hovstadius H, Lundgren D, Karling P. Elevated Faecal Calprotectin in Patients with a Normal Colonoscopy: Does It Matter in Clinical Practice? A Retrospective Observational Study. Inflamm Intest Dis 2021; 6:101-108. [PMID: 34124181 DOI: 10.1159/000513473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Faecal calprotectin (FC) is commonly used as a diagnostic tool for patients with gastrointestinal (GI) symptoms. However, there is uncertainty in daily clinical practice how to interpret an elevated FC in patients with a normal colonoscopy. We investigated if patients with a normal colonoscopy but with an elevated FC more often were diagnosed with a GI disease in a 3-year follow-up period. Methods Patients referred for colonoscopy (n = 1,263) to the Umeå University Hospital endoscopy unit between 2007 and 2013 performed a FC test (CALPRO®) on the day before bowel preparation. A medical chart review was performed on all patients who had normal findings on their colonoscopy (n = 585, median age 64 years). Results Thirty-four percent of the patients (n = 202) with normal colonoscopy had elevated FC (>50 μg/g), and these patients were more frequently diagnosed with upper GI disease during the follow-up period than patients with normal FC levels (9.9 vs. 4.7%; p = 0.015). The upper GI diseases were mainly benign (i.e., gastritis). In a binary logistic regression analysis controlling for age, gender, nonsteroid anti-inflammatory drug use, and proton-pump inhibitor use, there was no difference for a new diagnosis of upper GI disease in the follow-up period (multivariate OR 1.70; 95% CI: 0.77-3.74). There was no difference in a new diagnosis of lower GI disease (6.4 vs. 5.2%; p = 0.545) or cardiovascular disease/death (multivariate OR 1.68; 95% CI: 0.83-3.42) in the follow-up period between patients with elevated versus normal FC levels. Conclusions In patients with a normal colonoscopy, a simultaneously measured increased FC level was not associated with an increased risk for significant GI disease during a follow-up period of 3 years.
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Affiliation(s)
- Henrik Hovstadius
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - David Lundgren
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
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15
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Sjöström B, Bredberg A, Mandl T, Alonso-Magdalena L, Ohlsson B, Lavasani S, Nouri M, Henriksson G. Increased intestinal permeability in primary Sjögren's syndrome and multiple sclerosis. J Transl Autoimmun 2021; 4:100082. [PMID: 33506194 PMCID: PMC7815467 DOI: 10.1016/j.jtauto.2021.100082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023] Open
Abstract
There is increasing evidence suggesting a role of intestinal dysfunction in a number of autoimmune diseases. Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease with a documented increased level of intestinal inflammation, whereas multiple sclerosis (MS) is an organ-specific autoimmune disease known to exhibit increased intestinal permeability. In this study we determine to what extent intestinal inflammation, analysed by a faecal calprotectin ELISA, is accompanied by altered intestinal wall permeability, as measured by a lactulose and mannitol intestinal absorption assay. Intestinal permeability was increased in both pSS and MS patients, while faecal calprotectin was elevated in pSS but normal in MS. Our findings suggest different mechanisms mediating a leaky gut in these two diseases: in pSS there is autoimmune attack directly on the intestinal wall; in MS, with autoimmunity being limited to the CNS, it may be due to a disturbed CNS regulation of enteric nerve function. Intestinal permeability analysed by sugar absorption is increased in primary Sjögren’s syndrome and multiple sclerosis. Intestinal wall inflammation as determined by faecal calprotectin is observed in pSS but not in MS. Leaky gut may be due to autoimmune targeting of the intestinal wall in pSS and to disturbed intestinal innervation in MS.
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Affiliation(s)
- Bitte Sjöström
- Department of Laboratory Medicine, Medical Microbiology, Lund University, Lund, Sweden
| | - Anders Bredberg
- Department of Laboratory Medicine, Medical Microbiology, Lund University, Lund, Sweden
| | - Thomas Mandl
- Department of Rheumatology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.,Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - Lucía Alonso-Magdalena
- Department of Neurology, Skåne University Hospital, Malmö/Lund, Lund University, Sweden.,Department of Clinical Sciences, Malmö, Neurology, Lund University, Sweden
| | - Bodil Ohlsson
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Shahram Lavasani
- Department of Biology, Lund University, Lund, Sweden.,ImmuneBiotech AB, Medicon Village, Lund, Sweden
| | - Mehrnaz Nouri
- Department of Biology, Lund University, Lund, Sweden.,Department of Clinical Sciences, Clinical Research Centre, Surgery Research Unit, Lund University, Malmö, Sweden
| | - Gunnel Henriksson
- Department of Laboratory Medicine, Medical Microbiology, Lund University, Lund, Sweden.,Department of Clinical Microbiology, Skåne University Hospital, Lund, Sweden
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16
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Demirbaş F, Çaltepe G, Comba A, Abbasguliyev H, Yurttan Uyar N, Kalaycı AG. Association of obesity and non-alcoholic fatty liver disease with the fecal calprotectin level in children. Arab J Gastroenterol 2020; 21:211-215. [PMID: 33248976 DOI: 10.1016/j.ajg.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/21/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND STUDY AIMS As the prevalence of obesity increased, obesity-related comorbidities such as non-alcoholic fatty liver disease (NAFLD) also increased. The aim of this study is to investigate the presence of intestinal inflammation by evaluating the faecal calprotectin (FC) level in children with obesity and NAFLD and to determine the factors affecting the FC level. PATIENTS AND METHODS Between August 2018 and November 2018, the FC levels of obese patients (Group 1a = NAFLD (n = 30) and 1b = without NAFLD (n = 30)) were prospectively compared to that of healthy children (Group 2, n = 20). Patients with BMI > 2 z-score were considered obese. NAFLD was identified with liver contrast and brightness on ultrasound. RESULTS Of the patients included in this study, 50 were male (62.5%), with a mean age of 11.4 ± 3.1 years. The mean FC levels were 121.6 ± 24.8 μg/g (19.5-800) in Group 1 (Group 1a = 128.4 and Group 1b = 84.5) and 43.8 ± 25.4 μg/g (19.5-144) in Group 2. In comparison, the FC levels were higher in Group 1. This difference was more significant when compared with Group 1a than with Group 2 (p = 0.018 and p = 0.007, respectively). When the FC levels of Group 1 (above 50) were compared to lower levels, the weight, BMI, waist circumference and waist circumference/height values were significantly higher (p = 0.006, p = 0.028, p = 0.035 and p = 0.026, respectively). CONCLUSION The FC level increased as a sign of intestinal inflammation in obese and NAFLD patients. This is directly proportional to the weight, waist circumference and waist-to-height ratio. It is thought that FC, which is easily applicable and an inexpensive biomarker, can be used safely in demonstrating the presence of intestinal inflammation in obese children.
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Affiliation(s)
- Fatma Demirbaş
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kurupelit/Samsun 55200, Turkey.
| | - Gönül Çaltepe
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kurupelit/Samsun 55200, Turkey
| | - Atakan Comba
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kurupelit/Samsun 55200, Turkey
| | - Hasan Abbasguliyev
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kurupelit/Samsun 55200, Turkey
| | - Neval Yurttan Uyar
- Acibadem University, Faculty of Medicine, Department of Medical Microbiology, Istanbul 34010, Turkey
| | - Ayhan Gazi Kalaycı
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kurupelit/Samsun 55200, Turkey
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17
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Emad Y, Ragab Y, Hammam N, El-Shaarawy N, Fawzi M, Amer A, El-Makhzangy H, Ismail A, Ibrahim O, Hassan Y, Kamal A, Rasker JJ. The Clinical Utility of Faecal Calprotectin in Patients with Differentiated and Undifferentiated Spondyloarthritis: Relevance and Clinical Implications. Reumatol Clin (Engl Ed) 2020; 18:S1699-258X(20)30238-2. [PMID: 33234498 DOI: 10.1016/j.reuma.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. MATERIAL AND METHODS A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. RESULTS The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). CONCLUSIONS Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, AssiutUniversity, Assiut, Egypt; Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Magdy Fawzi
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Arwa Amer
- Rheumatology, Rehabilitation and Physical MedicineDepartment, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hesham El-Makhzangy
- Tropical Medicines Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ismail
- Dermatology Department, Faculty of Medicine, Al-Azhar University Cairo, Egypt
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, UK
| | - Yosra Hassan
- Clinical pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Kamal
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioural, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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18
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Nardone OM, Rispo A, Castiglione F. Noninvasive monitoring of inflammatory bowel disease in the post COVID-19 era. Dig Liver Dis 2020; 52:1236-1237. [PMID: 32741684 PMCID: PMC7368895 DOI: 10.1016/j.dld.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples Italy.
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples Italy
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19
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Magro F, Lopes J, Borralho P, Dias CC, Afonso J, Ministro P, Santiago M, Geboes K, Carneiro F. Comparison of the Nancy Index With Continuous Geboes Score: Histological Remission and Response in Ulcerative Colitis. J Crohns Colitis 2020; 14:1021-1025. [PMID: 31965158 DOI: 10.1093/ecco-jcc/jjaa010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Evidence has been supporting that histological activity of ulcerative colitis [UC] has relevance for the prediction of clinical outcomes in UC patients, such as clinical relapse. In this study, we aimed to compare two histological indexes-the continuous Geboes score [GS] and the Nancy index [NI] -regarding their definitions of histological remission and response, and to determine the ability of faecal calprotectin [FC] levels to discriminate between these histological statuses according to the NI. METHODS A large cohort of UC patients [N = 422] who were previously enrolled in other studies was analysed. RESULTS GS and NI were shown to be strongly correlated [correlation coefficient: 0.882, p <0.001], indicating high accordance in the classification of patients as having/not having histological remission and response. FC levels moderately correlated with NI regarding these histological statuses [correlation coefficient: 0.481, p <0.001], moderately predicted the absence of remission defined by NI >0 {area under the curve (AUC) 0.667 (95% confidence interval [CI] 0.609-0.724)}, and were good predictors of the absence of histological response defined by NI >1 (AUC 0.825 [95% CI 0.777-0.872]). The optimal FC cut-offs determined to predict the NI-defined histological remission and response were 91 μg/g and 106 μg/g, when maximising the negative predictive value [NPV]. CONCLUSIONS Due to the higher applicability of the NI, this study encourages the systematic use of this histological index to assess histological remission and response in UC patients.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Mafalda Santiago
- CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Ghent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal.,Institute of Research and Innovation in Health [i3S], University of Porto, Porto, Portugal
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Boube M, Laharie D, Nancey S, Hebuterne X, Fumery M, Pariente B, Roblin X, Peyrin-Biroulet L, Minet-Quinard R, Pereira B, Bommelaer G, Buisson A. Variation of faecal calprotectin level within the first three months after bowel resection is predictive of endoscopic postoperative recurrence in Crohn's disease. Dig Liver Dis 2020; 52:740-744. [PMID: 32444250 DOI: 10.1016/j.dld.2020.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early prediction of postoperative recurrence (POR) remains a major concern in Crohn's disease (CD). AIMS To assess serial faecal calprotectin (Fcal) monitoring within the first three months to predict CD endoscopic POR. METHODS In a multicenter randomized controlled trial, CD patients received azathioprine 2.5 mg/kg/day with oral curcumin (3 g/day) or placebo. Fcal was measured at baseline, one month (M1) and M3. Endoscopic POR at M6 was defined as Rutgeerts' index ≥ i2b (central reading). RESULTS Among the 48 patients included, there was no significant difference of median Fcal levels at baseline (p = 0.15), M1 (p = 0.44) and M3 (p = 0.28) between patients with or without endoscopic POR at M6. Fcal kinetics during the first 3 months after surgery was significantly different between the patients with or without POR at M6 (p = 0.021). The median variation between Fcal level at baseline and M3 (ΔFcal M3-M0) was significantly higher in patients with endoscopic POR compared to those without POR (p = 0.01). ΔFcal M3-M0 >+10% demonstrated the best performances to predict endoscopic POR at M6 (AUC=0.73, sensitivity=64.7%[41.1-82.7], specificity=87.5%[68.0-96.3], negative predictive value=77.8%[57.5-91.4] and positive predictive value=78.6%[49.2-95.3]). CONCLUSION Fcal variation within the first three months after ileocolonic resection is a promising predictor of early endoscopic POR in CD patients.
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Affiliation(s)
- Mathilde Boube
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - David Laharie
- Gastroenterology Department, University Hospital, Bordeaux, France
| | - Stéphane Nancey
- Hospices Civils de Lyon, Lyon-Sud hospital, Gastroenterology, Pierre Benite, France
| | - Xavier Hebuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice and University of Nice Sophia-Antipolis, Nice, France
| | - Mathurin Fumery
- Gastroenterology Department, University Hospital, Amiens, France
| | | | - Xavier Roblin
- Gastroenterology Department, University Hospital, Saint-Etienne, France
| | | | - Régine Minet-Quinard
- CHU Clermont-Ferrand, Laboratoire de Biochimie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Gilles Bommelaer
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France.
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21
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Fauny M, D'Amico F, Bonovas S, Netter P, Danese S, Loeuille D, Peyrin-Biroulet L. Faecal Calprotectin for the Diagnosis of Bowel Inflammation in Patients With Rheumatological Diseases: A Systematic Review. J Crohns Colitis 2020; 14:688-693. [PMID: 31858121 DOI: 10.1093/ecco-jcc/jjz205] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Endoscopic and histological gut inflammation are present in half of patients with ankylosing spondylitis [AS] or spondyloarthritis [SpA]. We performed a systematic literature review on the use of faecal calprotectin [FC] in patients with rheumatic diseases. METHODS Searches of the PubMed, Web of Science, and Cochrane Library databases were performed up to September 2019 to identify all studies including adult patients with confirmed diagnosis of SpA or AS. RESULTS Seven studies met the inclusion criteria: six prospective observational studies and one retrospective observational study. Study populations consisted of SpA patients in four studies and AS patients in three studies. In six studies, an ELISA test was used for FC levels and in one case, a semi-quantitative assay was adopted. In all included studies, patients with SpA or AS had elevated FC levels, ranging from 21.2% to 70.7% of patients. In six studies, patients with increased FC levels had macroscopic mucosal inflammation, ranging from 11% to 80% of cases. Four studies highlighted the presence of microscopic alterations in patients with high FC levels, ranging from 41.7% to 100% of patients. An FC cut-off level predicting the inflammatory bowel disease [IBD] occurrence was found in two studies: 266 mg/kg and 132 mg/kg, with sensitivity and specificity of 100%, 78.7% and 66.7%, 76.9%, respectively. CONCLUSIONS Faecal calprotectin is a useful and non-invasive marker to predict IBD in patients with SpA or AS. Gut histological and macroscopic mucosal inflammation were found in up to 100% and 80% of rheumatological patients with increased FC levels.
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Affiliation(s)
- Marine Fauny
- Rheumatology Department, University Hospital of Nancy, Nancy, France
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University of Lorraine, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire [IMoPA]. UMR-7365 CNRS, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Damien Loeuille
- Rheumatology Department, University Hospital of Nancy, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire [IMoPA]. UMR-7365 CNRS, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University of Lorraine, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
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Di Nardo G, Esposito F, Ziparo C, Strisciuglio C, Vassallo F, Di Serafino M, Villa MP, Parisi P, Evangelisti M, Pacchiarotti C, Corleto VD. Faecal calprotectin and ultrasonography as non-invasive screening tools for detecting colorectal polyps in children with sporadic rectal bleeding: a prospective study. Ital J Pediatr 2020; 46:66. [PMID: 32434534 PMCID: PMC7238517 DOI: 10.1186/s13052-020-00828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding. Although colonoscopy is widely used in paediatric patients, it requires bowel preparation and general anaesthesia or deep sedation, and in rare cases, it can cause complications. Non-invasive screening techniques able to predict polyps in children with isolated and sporadic rectal bleeding may play a key role in the selection of patients needing colonoscopy. Methods We enrolled all children undergoing colonoscopy for isolated and sporadic rectal bleeding to determine the diagnostic accuracy of faecal calprotectin, ultrasonography (US) and digital rectal examination as diagnostic methods for screening colorectal polyps. Results A total of 26 of 59 enrolled patients (44.1%) had colonic polyps, one patient had multiple polyps, and 23% of children had polyps proximal to the splenic flexure. The diagnostic accuracy of faecal calprotectin for detecting colorectal polyps was 96.6%, with a sensitivity of 100%. False-positive faecal calprotectin was shown in 2 patients with non-steroidal anti-inflammatory drug-related lesions. The diagnostic accuracy of ultrasound was 77.9%. Polyps not seen with ultrasound tended to be relatively smaller (1.5 vs 2.3, p = 0.001) and located in the rectum. The combined use of FC, US and digital rectal examination obtained a specificity and PPV of 100%. Conclusions FC combined with US and digital rectal examination is a good and promising non-invasive screening test for detecting colorectal polyps in children with isolated and sporadic rectal bleeding.
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Affiliation(s)
- Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
| | - Francesco Esposito
- Pediatric Radiology Unit, Santobono-Pausilipon Children Hospital, Naples, Italy
| | - Chiara Ziparo
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Vassallo
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Marco Di Serafino
- General and Emergency Radiology Unit, Antonio Cardarelli Hospital, Naples, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Claudia Pacchiarotti
- Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Vito Domenico Corleto
- Gastroenterology and Gastrointestinal Endoscopy Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
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Sánchez-Hernández JG, Pérez-Blanco JS, Rebollo N, Muñoz F, Prieto V, Calvo MV. Biomarkers of disease activity and other factors as predictors of adalimumab pharmacokinetics in inflammatory bowel disease. Eur J Pharm Sci 2020; 150:105369. [PMID: 32416256 DOI: 10.1016/j.ejps.2020.105369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022]
Abstract
Inflammatory bowel disease (IBD) is commonly treated with adalimumab. The main objective of the study was to develop a population pharmacokinetic model of adalimumab in IBD patients evaluating the potential biomarkers of disease activity and other factors and its implications in adalimumab dosing. A prospective observational study was performed in adult patients diagnosed with Crohn's disease and ulcerative colitis treated with adalimumab and following a proactive therapeutic drug monitoring of serum concentrations. Adalimumab serum concentrations (ASC) were quantified mainly prior the administration using an enzyme-linked immunosorbent assay (ELISA). A population pharmacokinetic model was developed based on 303 ASC data of 104 IBD patients using non-linear mixed effect modelling approach. Sixty-five ASC from 20 additional patients were randomly selected as an external validation group. A one-compartment model with first order absorption and elimination best describe the ASC time course. Body mass index (BMI), faecal calprotectin (FCP), unexplained decline in ASC and the specific administration pen device exhibited significant influence on apparent clearance (p-value < 0.001). FCP was the inflammatory activity biomarker showing the most relevant impact on adalimumab exposure, higher than C-reactive protein and albumin, and may be useful for adalimumab dosing adjustment. The population-based pharmacokinetic model developed adequately characterized adalimumab exposure in IBD patients. The unexplained decline in ASC, FCP, BMI and the specific administration pen device were identified as meaningful variables significantly influencing adalimumab pharmacokinetics.
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Affiliation(s)
- José Germán Sánchez-Hernández
- Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain; Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain; Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.
| | - Jonás Samuel Pérez-Blanco
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain; Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Noemí Rebollo
- Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain; Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain; Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Fernando Muñoz
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Gastroenterology Service, University Hospital of Salamanca, Salamanca, Spain
| | - Vanessa Prieto
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Gastroenterology Service, University Hospital of Salamanca, Salamanca, Spain
| | - María Victoria Calvo
- Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain; Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain; Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
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24
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E Penna FGC, Rosa RM, da Cunha PFS, de Souza SCS, de Abreu Ferrari MDL. Faecal calprotectin is the biomarker that best distinguishes remission from different degrees of endoscopic activity in Crohn's disease. BMC Gastroenterol 2020; 20:35. [PMID: 32054445 PMCID: PMC7020548 DOI: 10.1186/s12876-020-1183-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background Effective control of the inflammatory process in Crohn’s disease (CD) is reflected in intestinal mucosal healing. The performances of faecal calprotectin (fcal), clinical and serologic parameters in the inflammatory activity evaluation and their correlation to the simple endoscopic score (SES-CD) are the goals of this study. Methods Patients with CD referred for ileocolonoscopy were prospectively included and distributed according to the degree of endoscopic inflammatory activity into remission, mild activity, and moderate to severe activity groups. The different degrees of endoscopic activity were correlated with the following indexes: Crohn’s disease activity index (CDAI), fCal, serum C-reactive protein (CRP), and haemogram. The control group comprised individuals without known intestinal disease who were referred for colorectal cancer screening. Results Eighty colonoscopies were performed in patients with CD and 21 in the control group. The control group had a lower median fCal (59.7 mcg/g) than patients with CD (683 mcg/g, p < 0.001). A moderate Spearman correlation occurred between SES-CD and CRP (r = 0.525), fCal (r = 0.450), and CDAI (r = 0.407), while a weak correlation was found with the platelet count (r = 0.257). Only fCal distinguished patients in remission from those with mild activity (236.6 mcg/g × 654.9 mcg/g, p = 0.014) or moderate to severe activity (236.6 mcg/g × 1128 mcg/g, p < 0.001). An fCal cut-off of 155 mcg/g was sensitive (96%) and accurate (78%) for the diagnosis of endoscopic activity. Conclusions fCal provides greater diagnostic accuracy than the other activity markers for endoscopic activity of patients with CD, moderate correlation to SES-CD, and a capacity to discriminate patients in remission from those with mild or moderate to severe activity.
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Affiliation(s)
- Francisco Guilherme Cancela E Penna
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, second floor. Bairro: Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil.
| | - Rodrigo Macedo Rosa
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, second floor. Bairro: Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil
| | - Pedro Ferrari Sales da Cunha
- Medical student, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190. Bairro: Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil
| | - Stella Cristina Silva de Souza
- Medical student, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190. Bairro: Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil
| | - Maria de Lourdes de Abreu Ferrari
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190. Bairro: Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil
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Hart L, Chavannes M, Kherad O, Maedler C, Mourad N, Marcus V, Afif W, Bitton A, Lakatos PL, Brassard P, Bessissow T. Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis. J Crohns Colitis 2020; 14:46-52. [PMID: 31314884 DOI: 10.1093/ecco-jcc/jjz107] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Faecal calprotectin [FC] is a reliable surrogate marker for disease activity in ulcerative colitis [UC]; however, there are no consensus cut-off values for remission. The study aim was to correlate FC with Mayo Endoscopic Score [MES] and histological disease activity of UC patients in clinical remission. METHODS Our study recruited adult UC patients at the McGill IBD Center between 2013 and 2017. Patients in clinical remission [partial Mayo score ≤2], undergoing endoscopy for disease activity or dysplasia surveillance, were enrolled. Before bowel preparation, FC was collected. MES was documented during colonoscopy. Biopsies were taken; histological activity was assessed using Geboes score and the presence of basal plasmacytosis. RESULTS A total of 185 patients were recruited. The area under the curve [AUC] in receiver operating characteristic [ROC] analysis to predict MES 1-3 [from 0] was 0.743 [95% CI 0.67-0.82; p <0.001] with an FC cut-off value 170 µg/g [64% sensitivity, 74% specificity], and to predict MES 2-3 [from 0-1] was 0.722 [95% CI 0.61-0.83; p <0.001] with an FC cut-off value 170 µg/g [69% sensitivity, 65% specificity]. To differentiate MES 0 from MES 1, an FC value 130 µg/g yields a 70% sensitivity and 68% specificity. The AUC in ROC analysis to predict Geboes <3.1 was 0.627 [95% CI 0.55-0.71; p = 0.003], with an FC value 135 µg/g [54% sensitivity, 69% specificity]. CONCLUSIONS In this large study, FC ≥170 µg/g predicts endoscopic activity and FC ≥135 µg/g predicts histological activity. Therefore in clinical practice, lower faecal calprotectin thresholds can be chosen to optimise identification of patients with ongoing endoscopic and histological disease activity.
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Affiliation(s)
- Lara Hart
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Mallory Chavannes
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Omar Kherad
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Internal Medicine, Hôpital de la Tour and University of Geneva, Geneva, Switzerland
| | - Chelsea Maedler
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Nathalie Mourad
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Victoria Marcus
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Waqqas Afif
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alain Bitton
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada.,Division of Gastroenterology, Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Paul Brassard
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Talat Bessissow
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, QC, Canada
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Shentova R, Baycheva M, Hadjiiski P, Kofinova D, Yaneva P. Role of faecal calprotectin as a predictor of endoscopic activity in paediatric patients with ulcerative colitis. Gastroenterol Hepatol 2019; 43:57-61. [PMID: 31733888 DOI: 10.1016/j.gastrohep.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/31/2019] [Accepted: 08/21/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Colonoscopy is currently considered to be the gold standard for evaluation of colonic mucosa inflammation in patients with ulcerative colitis (UC), but the procedure is invasive and cannot be repeated frequently, especially in the paediatric population. The aim of this study was to assess the role of faecal calprotectin (FC) as a predictor of endoscopic disease activity in paediatric patients with UC in clinical remission. MATERIAL AND METHODS Single-centre prospective study. Clinical remission was defined as Paediatric Ulcerative Colitis Activity Index <10. Endoscopic findings were assessed according to the Mayo Endoscopic Subscore (MES). MES≤1 was defined as endoscopic remission. All participants provided fresh faecal samples for measurement of FC. RESULTS A total of 34 visits of 24 children with UC were included in the study. There was a strong positive correlation between FC levels and endoscopic disease activity (n=34, r=0.83, p<0.001). The median FC levels in the subgroup with endoscopic activity (MES 2-3) were significantly higher than the median FC levels in the subgroup without endoscopic activity (MES≤1) (1000μg/g, IQR 575-1800μg/g vs. 100μg/g, IQR 80-223μg/g, p<0.001). At a cut-off of 298.5μg/g, FC had 92.3% sensitivity, 95.2% specificity and an AUROC 0.974 (SE 0.023, 95% CI 0.93-1, p<0.001) to predict endoscopic activity. DISCUSSION FC is an accurate surrogate marker of endoscopic activity in children with clinically quiescent UC.
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Affiliation(s)
- Rayna Shentova
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Pediátrico "Prof. Ivan Mitev", Universidad de Medicina de Sofía, Bulgaria.
| | - Mila Baycheva
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Pediátrico "Prof. Ivan Mitev", Universidad de Medicina de Sofía, Bulgaria
| | - Petio Hadjiiski
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Pediátrico "Prof. Ivan Mitev", Universidad de Medicina de Sofía, Bulgaria
| | - Denitza Kofinova
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Pediátrico "Prof. Ivan Mitev", Universidad de Medicina de Sofía, Bulgaria
| | - Penka Yaneva
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Pediátrico "Prof. Ivan Mitev", Universidad de Medicina de Sofía, Bulgaria
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Cremer A, Ku J, Amininejad L, Bouvry MR, Brohet F, Liefferinckx C, Devière J, van Gossum A, Smet J, Stordeur P, Franchimont D. Variability of Faecal Calprotectin in Inflammatory Bowel Disease Patients: An Observational Case-control Study. J Crohns Colitis 2019; 13:1372-1379. [PMID: 30944925 DOI: 10.1093/ecco-jcc/jjz069] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Several factors have been reported to affect faecal calprotectin [FC] values, and significant variation in FC concentrations has been observed in inflammatory bowel disease [IBD] patients. We aimed to evaluate FC variability in IBD patients, and to assess the robustness of a single stool punch. METHODS This is a single-centre observational case-control study. Disease activity was assessed using endoscopic and clinical activity scores, as well as C-reactive protein levels. Stool samples were collected twice within a 1 to 6 days interval, and FC was measured on punches and homogenates by fluorometric enzyme immunocapture assay. RESULTS In all, 260 stool samples were collected from 120 patients. Intrastool variability was low, with an intraclass correlation coefficient for single measures between three punches from a single stool sample of 0.91, and median coefficient of variation [CV] of 17%. CV of two stool samples a few days apart [intra-individual variability] were significantly higher [p <0.01] with median CV of 36%. FC standard deviations correlated with mean FC levels either for intrastool or for intra-individual variability, with a Spearman's coefficient of rank correlation of 0.85 and 0.78, respectively [p <0.01]. Disease type, location, activity, and FC levels did not influence variability. CONCLUSIONS A single stool punch is reliable for FC measurement, considering that intrastool variability is low. Intra-individual variability a few days apart is significantly higher. Therefore, decision-making strategies based on single measurements should consider this variability, to determine the minimum optimal variation to be achieved, rather than a cut-off, especially in high FC levels.
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Affiliation(s)
- Anneline Cremer
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.,Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jade Ku
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Leila Amininejad
- Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Rose Bouvry
- Immunobiology Clinic, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabian Brohet
- Immunobiology Clinic, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Claire Liefferinckx
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.,Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - André van Gossum
- Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Smet
- Immunobiology Clinic, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Stordeur
- Immunobiology Clinic, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Denis Franchimont
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.,Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Martins S, Garcia D, Farinha R, Guimarães JT. Comparison of a rapid test and an automated method for faecal calprotectin measurement. Pract Lab Med 2019; 17:e00133. [PMID: 31649985 PMCID: PMC6804501 DOI: 10.1016/j.plabm.2019.e00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/27/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sandra Martins
- Clinical Pathology Department, São João University Hospital Centre, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Corresponding author. Clinical Pathology Department, São João Hospital Centre, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - David Garcia
- Clinical Pathology Department, São João University Hospital Centre, Porto, Portugal
| | - Rui Farinha
- Clinical Pathology Department, São João University Hospital Centre, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - João Tiago Guimarães
- Clinical Pathology Department, São João University Hospital Centre, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Biochemistry Unit, Biomedicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
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29
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Wang C, Baer HM, Gaya DR, Nibbs RJB, Milling S. Can molecular stratification improve the treatment of inflammatory bowel disease? Pharmacol Res 2019; 148:104442. [PMID: 31491469 PMCID: PMC6902263 DOI: 10.1016/j.phrs.2019.104442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a debilitating chronic inflammatory disease of the gastrointestinal (GI) tract. It affects more than 3.5 million people in the western world and places a huge financial burden on healthcare systems. IBD is highly heterogeneous; disease severity and outcomes in IBD are highly variable, and patients may experience episodes of relapse and remission. However, treatment often follows a step-up model whereby the patients start with anti-inflammatory agents (corticosteroids or immunosuppressants) and step-up to monoclonal anti-tumour necrosis factor-α (TNFα) antibodies and then other biologics if the initial drugs cannot control disease. Unfortunately, many patients do not respond to the costly biologics, and thus often still require gut-resective surgery, which decreases quality of life. In order to decrease rates of surgery and ineffective treatments, it is important to identify markers that accurately predict disease progression and treatment responses, to inform decisions about the best choice of therapeutics. Here we examine molecular approaches to patient stratification that aim to increase the effectiveness of treatments and potentially reduce healthcare costs. In the future, it may become possible to stratify patients based on their suitability for specific molecular-targeted therapeutic agents, and eventually use molecular stratification for personalised medicine in IBD.
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Affiliation(s)
- Claire Wang
- Institute of Infection, Inflammation & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hannah M Baer
- Institute of Infection, Inflammation & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Daniel R Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Robert J B Nibbs
- Institute of Infection, Inflammation & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Simon Milling
- Institute of Infection, Inflammation & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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30
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Karling P, Lundgren D, Eklöf V, Palmqvist R, Hultdin J. Improved monitoring of inflammatory activity in patients with ulcerative colitis by combination of faecal tests for haemoglobin and calprotectin. Scand J Clin Lab Invest 2019; 79:341-346. [PMID: 31164011 DOI: 10.1080/00365513.2019.1622148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Faecal calprotectin (FC) tests and faecal immunological tests (FIT) for haemoglobin have been used to monitor disease activity in patients with ulcerative colitis (UC) but used alone they have some limitation concerning the predictive ability. We aimed to test if an FC test used in combination with FIT could improve the predictive ability. Consecutive out-patients with UC (n = 93) who were admitted for colonoscopy completed a single faecal sample before the start of bowel preparation. A quantitative CALPRO® calprotectin ELISA test and a qualitative FIT (cut-off < 40 ng/mL) were analyzed. An estimated Mayo score and a score of histological inflammation was performed blinded to the result of the faecal tests. The sensitivity, specificity, negative predictive value and positive predictive value for endoscopic inflammation (Mayo score > 1) was for FIT 85%, 83%, 96%, 57% and for FC > 186 µg/g 73%, 87%, 87%, 54%. Corresponding results for FIT*FC > 186 µg/g (at least one test positive) were 92%, 69%, 97%, 43%. For detecting moderate/severe histological inflammation the results were for FIT 69%, 79%, 92%, 43%, for FC > 75 µg/g 95%, 62%, 98%, 41%, and for FIT*FC > 75 µg/g 100%, 60%, 100%, 36%. None of the markers alone or in combination were useful to predict deep remission (Mayo score = 0 and no histological inflammation). We conclude that using the combination of an FC test and FIT shows minor improvement in predictive ability for inflammatory activity and remission in patients with UC.
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Affiliation(s)
- Pontus Karling
- a Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University , Umeå , Sweden
| | - David Lundgren
- a Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University , Umeå , Sweden
| | - Vincy Eklöf
- b Department of Medical Biosciences, Division of Pathology, Umeå University , Umeå , Sweden
| | - Richard Palmqvist
- b Department of Medical Biosciences, Division of Pathology, Umeå University , Umeå , Sweden
| | - Johan Hultdin
- c Department of Medical Biosciences, Division of Clinical Chemistry, Umeå University , Umeå , Sweden
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31
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Sollelis E, Quinard RM, Bouguen G, Goutte M, Goutorbe F, Bouvier D, Pereira B, Bommelaer G, Buisson A. Combined evaluation of biomarkers as predictor of maintained remission in Crohn’s disease. World J Gastroenterol 2019; 25:2354-2364. [PMID: 31148906 PMCID: PMC6529885 DOI: 10.3748/wjg.v25.i19.2354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The individual performances and the complementarity of Crohn’s disease (CD) activity index (CDAI), C-reactive protein (CRP) and faecal calprotectin (Fcal) to monitor patients with CD remain poorly investigated in the era of “tight control” and “treat to target” strategies.
AIM To assess CDAI, CRP and Fcal variation, alone or combined, after 12 wk (W12) of anti-tumor necrosis factor (TNF) therapy to predict corticosteroids-free remission (CFREM = CDAI < 150, CRP < 2.9 mg/L and Fcal < 250 μg/g with no therapeutic intensification and no surgery) at W52.
METHODS CD adult patients needing anti-TNF therapy with CDAI > 150 and either CRP > 2.9 mg/L or Fcal > 250 μg/g were prospectively enrolled.
RESULTS Among the 40 included patients, 13 patients (32.5%) achieved CFREM at W52. In univariable analysis, CDAI < 150 at W12 (P = 0.012), CRP level < 2.9 mg/L at W12 (P = 0.001) and Fcal improvement at W12 (Fcal < 300 μg/g; or, for patients with initial Fcal < 300 μg/g, at least 50% decrease of Fcal or normalization of Fcal (< 100 μg/g) (P = 0.001) were predictive of CFREM at W52. Combined endpoint (CDAI < 150 and CRP ≤ 2.9 mg/L and FCal improvement) at W12 was the best predictor of CFREM at W52 with positive predictive value = 100.0% (100.0-100.0) and negative predictive value = 87.1% (75.3-98.9). In multivariable analysis, Fcal improvement at W12 [odd ratio (OR) = 45.1 (2.96-687.9); P = 0.03] was a better predictor of CFREM at W52 than CDAI < 150 [OR = 9.3 (0.36-237.1); P = 0.145] and CRP < 2.9 mg/L (0.77-278.0; P = 0.073).
CONCLUSION The combined monitoring of CDAI, CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.
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Affiliation(s)
- Elisa Sollelis
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| | - Régine Minet Quinard
- Biochemistry laboratory, University Hospital G. Montpied, Clermont-Ferrand F-63000, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes F-35000, France
| | - Marion Goutte
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| | - Félix Goutorbe
- Gastroenterology Department, Hospital of Bayonne, Bayonne F-64100, France
| | - Damien Bouvier
- Biochemistry laboratory, University Hospital G. Montpied, Clermont-Ferrand F-63000, France
| | - Bruno Pereira
- Biostatistics Unit, DRCI, University Hospital, Clermont-Ferrand F-63000, France
| | - Gilles Bommelaer
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
| | - Anthony Buisson
- Inserm 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
- Inserm U1071, M2iSH, USC-INRA 2018, Université Clermont Auvergne, Clermont-Ferrand F-63000, France
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32
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Walsh A, Kormilitzin A, Hinds C, Sexton V, Brain O, Keshav S, Uhlig H, Geddes J, Goodwin G, Peters M, Collins G, Travis S. Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis-a Prospective Analysis. J Crohns Colitis 2019; 13:424-430. [PMID: 30445625 DOI: 10.1093/ecco-jcc/jjy184] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Faecal calprotectin [FCal] levels are used as a surrogate marker for mucosal inflammation, but thresholds for defining endoscopic or histological disease activity in ulcerative colitis [UC] remain unclear. METHODS Using validated indices, prospective measurements of FCal, symptoms [Simple Colitis Clinical Activity Index, SCCAI], endoscopic [Ulcerative Colitis Endoscopic Index of Severity, UCEIS] and histological activity [Nancy index] were made over 6 months in patients enrolled into the TrueColours UC web-based monitoring programme. Repeated measurements correlation was performed between FCal and SCCAI, UCEIS, and Nancy indices using definitions for remission and active disease [UCEIS: remission ≤1, active ≥4; Nancy: remission ≤1, active ≥2; combined criteria: remission UCEIS ≤1 and Nancy ≤1, active UCEIS ≥4 and Nancy ≥2]. Receiver operating characteristic curves investigated FCal thresholds after maximising sensitivity for active disease. RESULTS In 39 patients followed prospectively for 6 months, correlation coefficients between FCal and SCCAI, UCEIS, and Nancy indices were 0.271 (95% confidence interval [CI] 0.114-0.415), 0.741 [95% CI 0.289-0.922], and 0.876 [95% CI 0.605-0.965], respectively. Median FCal thresholds for remission using endoscopic, histological, or combined criteria were 71 μg/g [range 8-624], 91 μg/g [range 8-858], and 67 μg/g [range 8-479], respectively. The FCal threshold above which active disease was confirmed was 187 μg/g for UCEIS (area under the curve [AUC] 0.915), 72 μg/g for Nancy [AUC 0.824], and 187 μg/g for combined endoscopic and histological criteria [AUC 0.936]. CONCLUSIONS Correlation between FCal and symptoms in UC is weak. In contrast, the correlation between FCal and endoscopic or histological activity is strong. An FCal ≥72 μg/g indicates histological inflammation [Nancy ≥2] and ≥187 μg/g indicates endoscopically active disease [UCEIS ≥4], whether combined with histopathology or not.
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Affiliation(s)
- Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.,Linacre College, University of Oxford, Oxford, UK
| | - Andrey Kormilitzin
- Mathematical Institute, Andrew Wiles Building, University of Oxford, Oxford, UK.,Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | | | - Vanashree Sexton
- Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Satish Keshav
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Holm Uhlig
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - John Geddes
- Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | - Guy Goodwin
- Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | - Michele Peters
- Medical Sciences Division, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gary Collins
- Department of Orthopaedics, Rheumatology and Musculoskeletal Medicine, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Simon Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.,Linacre College, University of Oxford, Oxford, UK
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Stevens TW, D'Haens GR, Duijvestein M, Bemelman WA, Buskens CJ, Gecse KB. Diagnostic accuracy of faecal calprotectin in patients with active perianal fistulas. United European Gastroenterol J 2019; 7:496-506. [PMID: 31065367 PMCID: PMC6488796 DOI: 10.1177/2050640619834464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background Faecal calprotectin (FC) is a marker of mucosal inflammation. Objective The aim of this study was to determine the diagnostic accuracy of FC to (a) differentiate between perianal fistulizing Crohn's disease (pCD) and cryptoglandular perianal fistulas; and (b) detect mucosal inflammation in pCD. Methods Patients with active perianal fistulas who had FC measured and a complete ileocolonoscopy within 10 weeks were retrospectively included. Results Fifty-six patients were included (pCD, n = 37) of whom 19 pCD patients exhibited ulcers. FC was significantly higher in pCD compared to cryptoglandular fistulas (µg/g) (708.0 (207.0-1705.0) vs 32.0 (23.0-77.0), p < 0.001). Area-under-the-curve (AUC) value for FC receiver operating characteristic (ROC) statistics was 0.900. Optimal FC cut-off was ≥ 150 µg/g. To differentiate pCD from cryptoglandular fistulas in the absence of luminal inflammation, optimal cut-off remained ≥ 150 µg/g (AUC = 0.857, sensitivity = 0.81, specificity = 0.89, positive predictive value (PPV) = 93.8% and negative predictive value (NPV) = 70.8%). In pCD, FC was significantly increased in the presence of ulcers (1672.0 vs 238.0, p = 0.004). Optimal cut-off was ≥ 250 µg/g (AUC = 0.776; sensitivity = 0.89, specificity = 0.56, PPV - 68.0% and NPV = 83.0%). Conclusion FC discriminates pCD from cryptoglandular fistulas, even in the absence of intestinal ulcers. In active pCD, an elevated FC does not accurately predict the presence of ulcers and should be interpreted with caution.
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Affiliation(s)
- Toer W Stevens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Lundgren D, Eklöf V, Palmqvist R, Hultdin J, Karling P. Proton pump inhibitor use is associated with elevated faecal calprotectin levels. A cross-sectional study on subjects referred for colonoscopy. Scand J Gastroenterol 2019; 54:152-157. [PMID: 30676120 DOI: 10.1080/00365521.2019.1566493] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Faecal Calprotectin (FC) is a sensitive marker for gut inflammation. However, slightly elevated FC levels are also common in subjects without inflammation. We investigated the association between FC and clinical factors including concomitant use of medical therapy in patients with a normal colonoscopy. MATERIAL AND METHODS Out-patients (n = 1263) referred for colonoscopy, performed FC test (CALPRO) the day before the start of bowel preparation. All subjects answered questionnaires that included questions on the present and past health history, concomitant medical treatment and gastrointestinal symptoms (GSRS). A medical record chart review was performed to check for concomitant disease, cause of referral and the result of the colonoscopy including biopsies. Inclusion criteria were a normal colonoscopy. Exclusion criteria were inflammatory bowel disease, colon cancer and high-grade dysplasia. RESULTS Five hundred ninety subjects fulfilled the inclusion criteria and completed the study. Thirty-six per cent of the subjects had a FC >50 µg/g. In a logistic regression analysis, age (adjusted OR: 1.051; CI: 1.032-1.071), and the use of proton pump inhibitors (adjusted OR: 3.843; CI: 2.338-6.316), non-steroid anti-inflammatory drugs (adjusted OR: 2.411; CI: 1.162-5.002) and acetylsalicylic acid (adjusted OR: 2.934; CI: 1.085-3.448) were significantly associated with an elevated FC (>50 µg/g). CONCLUSIONS More than one-third of the patients with a normal colonoscopy performed in clinical routine had a slightly elevated FC level. Our results emphasise the need for attention to age, the use of proton pump inhibitors, non-steroid anti-inflammatory drugs and acetylsalicylic acid in the interpretation of FC tests in clinical practice.
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Affiliation(s)
- David Lundgren
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Vincy Eklöf
- b Department of Medical Biosciences/Pathology , Umeå University , Umeå , Sweden
| | - Richard Palmqvist
- b Department of Medical Biosciences/Pathology , Umeå University , Umeå , Sweden
| | - Johan Hultdin
- c Department of Medical Biosciences Division of Clinical Chemistry , Umeå University , Sweden
| | - Pontus Karling
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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35
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Kalla R, Boyapati R, Vatn S, Hijos G, Crooks B, Moore GT, Hall V, Lipscomb G, Gomollón F, Jahnsen J, Singh S. Patients' perceptions of faecal calprotectin testing in inflammatory bowel disease: results from a prospective multicentre patient-based survey. Scand J Gastroenterol 2018; 53:1437-1442. [PMID: 30451040 DOI: 10.1080/00365521.2018.1527394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite its success, there appears to be practical issues with Faecal Calprotectin (FC) testing in Inflammatory Bowel Diseases (IBD), including sample collection, delivery and processing delays. Patients' perception and barriers to FC testing are yet to be explored in clinical practice. METHOD A prospective patient survey was undertaken at IBD units in UK, Europe and Australia. A 9-point patient-based questionnaire was completed in clinic and included demographics, previous FC testing and FC sample difficulty rating score. Predictors of testing difficulty were derived using multivariable logistic regression analysis. RESULTS A total of 585 patients with IBD completed the survey; 306 males with a median age of 43 years (IQR: 31-54). There were 446 patients (76%) who had prior FC testing experience. Of these, 37% (n = 165) rated FC testing difficult; 'sample collection' (n = 106; 67%) being the most common reason reported. Multivariable regression analysis identified age <49 years (odds ratio (OR): 2.5, CI:1.6-4.0), disease duration <35 months (OR 1.4, CI:0.9-2.1) and testing location (UK centre: OR 1.9, CI:1.2-3.1) as predictors of a difficult FC rating score. CONCLUSIONS A total of 37% of patients find FC testing challenging, in particular those aged <49 years, disease duration <35 months. Further studies understanding and addressing these practical issues may aid higher FC uptake in clinic.
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Affiliation(s)
- Rahul Kalla
- a Department of Gastroenterology , Royal Bolton Hospital , Bolton , UK
| | - Ray Boyapati
- b Department of Gastroenterology , Monash Health , Melbourne , Australia
| | - Simen Vatn
- c Department of Gastroenterology , Akershus University Hospital , Akershus , Norway
| | - Gonzalo Hijos
- d Gastroenterology Unit , Clinical University Hospital Lozano Blesa , Zaragoza , Spain
| | - Benjamin Crooks
- a Department of Gastroenterology , Royal Bolton Hospital , Bolton , UK
| | | | - Veronica Hall
- a Department of Gastroenterology , Royal Bolton Hospital , Bolton , UK
| | - George Lipscomb
- a Department of Gastroenterology , Royal Bolton Hospital , Bolton , UK
| | - Fernando Gomollón
- d Gastroenterology Unit , Clinical University Hospital Lozano Blesa , Zaragoza , Spain
| | - Jørgen Jahnsen
- c Department of Gastroenterology , Akershus University Hospital , Akershus , Norway.,e Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Salil Singh
- a Department of Gastroenterology , Royal Bolton Hospital , Bolton , UK
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Akobeng AK. Clinical usefulness of the faecal calprotectin test in suspected paediatric inflammatory bowel disease. Acta Paediatr 2018; 107:2019-2023. [PMID: 29706011 DOI: 10.1111/apa.14374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/19/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022]
Abstract
AIM The faecal calprotectin (FC) test is increasingly being used in clinical practice to help select children with gastrointestinal symptoms who might have inflammatory bowel disease (IBD) and benefit from endoscopies. We provide an overview of the advantages and limitations of the FC test. METHODS PubMed was searched for meta-analyses that had investigated the diagnostic accuracy of the FC test and the pooled sensitivity and specificity for distinguishing IBD from non-IBD patients were used to calculate likelihood ratios (LR). These were applied to practical examples to explain how easily clinicians can use the results to modify pre-test probabilities of IBD and generate post-test probabilities for IBD. RESULTS The positive LR and negative LR of the FC test were 2.8 and 0.015, respectively. The usefulness of the FC test depended on the pre-test probability of IBD. When the pre-test probability of IBD was low, a positive FC test did not necessarily indicate IBD. However, because of the very small negative LR, a negative FC result virtually ruled out IBD in most cases. CONCLUSION The FC test should not be used indiscriminately in children with gastrointestinal symptoms but should be targeted at those who are likely to have IBD.
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Affiliation(s)
- Anthony K. Akobeng
- Sidra Medical and Research Center; Doha Qatar
- Weill Cornell Medical College; Cornell University; Doha Qatar
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Shimoyama T, Yamamoto T, Umegae S, Matsumoto K. Faecal calprotectin level for assessing endoscopic activity and predicting future clinical course in patients with moderately active ulcerative colitis undergoing granulomonocytapheresis: a prospective cohort study. BMC Gastroenterol 2018; 18:120. [PMID: 30068300 PMCID: PMC6090982 DOI: 10.1186/s12876-018-0853-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022] Open
Abstract
Background Calprotectin is a stable neutrophil protein, which can be measured in faecal samples. The faecal level of calprotectin increases during disease activity in ulcerative colitis (UC). Nonetheless, the relevance of faecal calprotectin (FC) measurement during granulomonocytapheresis (GMA) for UC has not yet been fully evaluated. This prospective study was to investigate the value of FC for assessing disease activity and predicting clinical course in UC patients undergoing GMA therapy. Methods One hundred and eighty-four patients with moderately active UC with endoscopic activity (Mayo endoscopic subscore [MES] = 2 or 3) received Adacolumn GMA therapy (10 apheresis sessions over consecutive 5 weeks). Patients who achieved clinical remission were subsequently given maintenance medications for 12 months. FC levels were measured at entry and after treatment. Results After GMA, 80 of the 184 patients (43%) achieved clinical remission, and 51 (28%) achieved mucosal healing (MH; MES = 0 or 1). The median FC level significantly decreased in patients who achieved MH (P = 0.02), but not in those without MH. Thirty-four patients (43%) relapsed during the 12-month follow-up. The median FC level at the end of GMA therapy was significantly higher in patients who subsequently relapsed than in those who maintained remission (149.5 vs 45.5 μg/g, P < 0.001). A cut off value of 114 μg/g had a sensitivity of 76% and a specificity of 85% to predict future relapse. Conclusions Our findings indicate that FC is a relevant biomarker, which is convenient to measure for assessing endoscopic activity and predicting relapse in patients who achieve remission following a course of GMA therapy.
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Affiliation(s)
- Takahiro Shimoyama
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyamacho, Yokkaichi, 510-0016, Japan
| | - Takayuki Yamamoto
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyamacho, Yokkaichi, 510-0016, Japan.
| | - Satoru Umegae
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyamacho, Yokkaichi, 510-0016, Japan
| | - Koichi Matsumoto
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyamacho, Yokkaichi, 510-0016, Japan
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Wall CL, Gearry RB, Day AS. Treatment of Active Crohn's Disease with Exclusive and Partial Enteral Nutrition: A Pilot Study in Adults. Inflamm Intest Dis 2018; 2:219-227. [PMID: 30221149 PMCID: PMC6135224 DOI: 10.1159/000489630] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/26/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIM Enteral nutrition (EN) is not commonly used for the treatment of adults with active Crohn's disease (CD), despite patient interest in nutrition-based alternatives to corticosteroids and evidence of efficacy in paediatric CD. The aim of this study was to assess the impact of 2 different EN regimens on disease symptoms, nutrition and inflammatory markers in young adults with active CD. METHODS A prospective non-randomized pilot study of adults aged 16-40 years with active CD on endoscopy or imaging was undertaken. Patients were sequentially recruited to use 2 weeks of exclusive EN (EEN) followed by either 6 weeks of EEN or partial EN (PEN) with usual diet. Assessments of disease symptoms, nutrition and inflammatory markers were undertaken at baseline and throughout the treatment. RESULTS Thirty-eight patients with active disease were recruited. Thirty-two (84$) patients completed 2 weeks of EEN and had significant improvements in disease symptoms (p = 0.003), serum c-reactive protein (CRP; p = 0.005), insulin-like growth factor-1 (p = 0.006) and faecal calprotectin (FC; p = 0.028). During the following 6 weeks, 21 patients continued EEN (14 [67$] completed treatment) and 11 patients used PEN (9 [82$] completed treatment). Initial improvements in symptoms, CRP and nutrition markers were sustained over the next 6 weeks on both treatments. FC non-significantly increased in 5 out of 9 patients who used PEN and at week 8 FC was greater than 500 µg/g in 9 out of 14 and 7 out of 9 patients who used exclusive or PEN respectively. There was no significant difference in clinical outcomes between the 2 groups at week 8. CONCLUSION Two weeks of EEN significantly improved disease symptoms, nutrition and inflammatory markers. Further treatment with exclusive or PEN maintained initial improvements.
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Affiliation(s)
- Catherine L. Wall
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard B. Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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Reenaers C, Bossuyt P, Hindryckx P, Vanpoucke H, Cremer A, Baert F. Expert opinion for use of faecal calprotectin in diagnosis and monitoring of inflammatory bowel disease in daily clinical practice. United European Gastroenterol J 2018; 6:1117-1125. [PMID: 30288273 DOI: 10.1177/2050640618784046] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background Despite many publications regarding the role of faecal calprotectin (FC) in inflammatory bowel disease (IBD), clear recommendations for its use in clinical practice are currently lacking in the literature. Aim The aim of this article is to provide practical guidance for clinicians for the use of FC in the detection and management of patients with IBD. Methods All relevant publications were analysed and practical statements were proposed based on a Delphi consensus approach. Results Different commercial assays have been developed but international standardisation is lacking. FC can help in the diagnosis process of IBD. In IBD, FC can predict response to therapy, detect subclinical inflammation and help to drive treatment decisions to achieve better endoscopic and clinical outcomes. After Crohn's surgery FC can identify patients with early endoscopic recurrence. Conclusion Although major therapeutic changes should not be based on FC alone, FC is a valuable tool to optimise the care for IBD patients.
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Affiliation(s)
| | - Peter Bossuyt
- Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Hilde Vanpoucke
- Department of Laboratory Medicine, AZ Delta, Roeselare-Menen, West-Vlaanderen, Belgium
| | - Anneline Cremer
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
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Yousuf H, Aleem U, Egan R, Maheshwari P, Mohamad J, McNamara D. Elevated Faecal Calprotectin Levels are a Reliable Non-Invasive Screening Tool for Small Bowel Crohn's Disease in Patients Undergoing Capsule Endoscopy. Dig Dis 2018; 36:202-208. [PMID: 29466790 DOI: 10.1159/000485375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Approximately 10% of Crohn's disease (CD) patients have this disease affecting the small bowel (SB) beyond the reach of Ileo-colonoscopy. Capsule endoscopy (SBCE) is the recommended investigation for SB disease. An accurate and inexpensive biomarker would help identify at-risk patients. AIM To examine the efficacy of faecal calprotectin (FC) and C-reactive protein (CRP) as predictors of SBCE findings in suspected and known CD. METHODS A prospective observational study. Consecutive patients referred for SBCE gave FC and CRP samples. The diagnostic accuracy for SB CD based on SBCE result was calculated for both FC and CRP. RESULTS Of 100 invitees, FC and SBCE results were available in 64 cases. Correlation between FC >50 µg/g and SBCE result was poor К = 0.163; sensitivity, specificity, positive predictive value (PPV) and negative predictive values for ileitis were 60, 61, 32 and 83% respectively. PPV and specificity improved at FC >100 µg/g, 76 and 40%, correlation remained fair, К = 0.259. Receiver operating characteristic analysis had a sensitivity of 47% and specificity of 90% for FC >194 µg/g. CRP alone or in combination was an inaccurate predictor of ileitis. CONCLUSION Our study suggests that FC level >194 µg/g may be a useful SBCE filter test, identifying patients at risk of SB CD.
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Affiliation(s)
- Hamid Yousuf
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | - Umair Aleem
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | - Roisin Egan
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | | | - Jafaar Mohamad
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | - Deidre McNamara
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland.,Trinity Academic Gastroenterology Group, Department of Clinical Medicine, Trinity College, Dublin, Ireland
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Baillet P, Cadiot G, Goutte M, Goutorbe F, Brixi H, Hoeffel C, Allimant C, Reymond M, Obritin-Guilhen H, Magnin B, Bommelaer G, Pereira B, Hordonneau C, Buisson A. Faecal calprotectin and magnetic resonance imaging in detecting Crohn’s disease endoscopic postoperative recurrence. World J Gastroenterol 2018; 24:641-650. [PMID: 29434453 PMCID: PMC5799865 DOI: 10.3748/wjg.v24.i5.641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess magnetic resonance imaging (MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn’s disease (CD).
METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo (5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence (POR) was defined as Rutgeerts’ index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.
RESULTS Apparent diffusion coefficient (ADC) was lower in patients with endoscopic POR compared to those with no recurrence (2.03 ± 0.32 vs 2.27 ± 0.38 × 10-3 mm²/s, P = 0.032). Clermont score (10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement (RCE) (129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity (MaRIA) (7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system (P = 0.056). ADC < 2.35 × 10-3 mm²/s [sensitivity = 0.85, specificity = 0.65, positive predictive value (PPV) = 0.85, negative predictive value (NPV) = 0.65] and RCE > 100% (sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cut-off values to identify endoscopic POR. Clermont score > 6.4 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), MaRIA > 3.76 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1 (sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR (114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR (sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).
CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.
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Affiliation(s)
- Pierre Baillet
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
| | - Guillaume Cadiot
- CHU de Reims, Service d’Hépato-Gastro Entérologie, Reims 51100, France
| | - Marion Goutte
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
| | - Felix Goutorbe
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- CH de Bayonne, Service d’Hépato-Gastro Entérologie, Bayonne 64100, France
| | - Hedia Brixi
- CHU de Reims, Service d’Hépato-Gastro Entérologie, Reims 51100, France
| | | | - Christophe Allimant
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
| | - Maud Reymond
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
| | - Hélène Obritin-Guilhen
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
| | - Benoit Magnin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
| | - Gilles Bommelaer
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand 63000, France
| | - Constance Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
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Fraser CG. Diagnostic work-up of patients presenting in primary care with lower abdominal symptoms: which faecal test and triage strategy should be used? BMC Med 2016; 14:139. [PMID: 27666321 PMCID: PMC5036202 DOI: 10.1186/s12916-016-0694-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/14/2016] [Indexed: 12/29/2022] Open
Abstract
Bowel endoscopy referrals from primary care have increased steadily over recent years. However, most patients do not have significant colorectal disease (SCD). Therefore, strategies to select those who would benefit most from endoscopy are of current interest. A recent study developed a multivariable diagnostic model for SCD with routine clinical information, extended with quantitative faecal calprotectin (f-C) point-of-care (POC) testing and/or qualitative POC faecal immunochemical test (FIT) for haemoglobin (f-Hb) results. This study used POC tests for both f-C and f-Hb; however, POC tests have many disadvantages and there are several reasons why quantitative measurements of f-Hb are advantageous. Quantitative faecal immunochemical tests have been used very successfully in triage of patients presenting in primary care as a rule-out test. Studies have compared f-C and f-Hb in this clinical context and consider that f-C is not required in diagnosis. A single quantitative f-Hb result, without any clinical information, could be sufficient to decide whom to refer for endoscopy and, because of the significant overlap of symptoms in those with and without SCD, could be the primary investigation performed.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0684-5 .
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Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK.
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Melchior C, Aziz M, Aubry T, Gourcerol G, Quillard M, Zalar A, Coëffier M, Dechelotte P, Leroi AM, Ducrotté P. Does calprotectin level identify a subgroup among patients suffering from irritable bowel syndrome? Results of a prospective study. United European Gastroenterol J 2016; 5:261-269. [PMID: 28344794 DOI: 10.1177/2050640616650062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/24/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome is a multifactorial disease. Although faecal calprotectin has been shown to be a reliable marker of intestinal inflammation, its role in irritable bowel syndrome remains debated. OBJECTIVE The aims of this prospective study were to select a subgroup of irritable bowel syndrome patients and to characterise those patients with high faecal calprotectin by systematic work-up. METHODS Calprotectin levels were determined by enzyme-linked immunosorbent assay test in consecutive irritable bowel syndrome patients fulfilling Rome III criteria in whom normal colonoscopy and appropriate tests had excluded organic disease. Calprotectin levels were compared in irritable bowel syndrome patients, healthy controls and patients with active and quiescent Crohn's disease. When the calprotectin level was higher than 50 µg/g, the absence of ANCA/ASCA antibodies and a normal small bowel examination were required to confirm irritable bowel syndrome diagnosis. Additional explorations included assessment of irritable bowel syndrome severity, anxiety and depression, impact on quality of life, glucose and fructose breath tests, rectal distension test by barostat and quantitative and qualitative assessment of inflammation on colonic biopsies. RESULTS Among the 93 irritable bowel syndrome patients (73% women; 66.7% with diarrhoea) recruited, 34 (36.6%) had reproducibly elevated calprotectin. Although they tended to be older than those with normal calprotectin (P = 0.06), there were no other differences between the two groups. When elevated, calprotectin was correlated with age (P = 0.03, r = 0.22). CONCLUSIONS Elevated faecal calprotectin was observed in one third of patients in this series, without any significant association with a specific clinical phenotype (except age) or specific abnormalities.
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Affiliation(s)
- Chloé Melchior
- Department of Gastroenterology, Rouen University Hospital, Rouen, France; Department of Physiology, Rouen University Hospital, Rouen, France; Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Moutaz Aziz
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Typhaine Aubry
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Guillaume Gourcerol
- Department of Physiology, Rouen University Hospital, Rouen, France; Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Muriel Quillard
- Department of Biochemistry, Rouen University Hospital, Rouen, France
| | - Alberto Zalar
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Moïse Coëffier
- Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Pierre Dechelotte
- Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Anne-Marie Leroi
- Department of Physiology, Rouen University Hospital, Rouen, France; Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Philippe Ducrotté
- Department of Gastroenterology, Rouen University Hospital, Rouen, France; Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France
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Lozoya Angulo ME, de Las Heras Gómez I, Martinez Villanueva M, Noguera Velasco JA, Avilés Plaza F. Faecal calprotectin, an useful marker in discriminating between inflammatory bowel disease and functional gastrointestinal disorders. Gastroenterol Hepatol 2016; 40:125-131. [PMID: 27260632 DOI: 10.1016/j.gastrohep.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/11/2016] [Accepted: 04/21/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Diagnostic discrimination between inflammatory bowel disease (IBD) and functional gastrointestinal disorders is complex, as they cause similar signs and symptoms. Faecal calprotectin (FC) is a useful marker in this context, and can be used to select patients who will most benefit from colonoscopy. The aim of this study was to evaluate the utility of FC in discriminating between organic disease and functional disorders. MATERIAL AND METHODS The study included 264 patients presenting with gastrointestinal complaints consistent with an organic pathology. FC levels were determined and diagnostic accuracy was assessed using the area under the curve obtained from the final diagnosis. RESULTS Calprotectin levels in organic bowel disease patients were significantly higher (median 254μg/g; 95% confidence interval [CI], interquartile range 105-588.5) than in functional disease patients (95μg/g; 95% CI, 47.25-243.92) (P<.0001). Similarly, in patients with IBD, the values obtained were higher (270.85μg/g; 95% CI, 96.85-674.00) than in those with irritable bowel syndrome (79.70μg/g; 95% CI, 36.50-117.25) (P<.0001). For a cut-off of 150μg/g, FC had an area under the ROC curve to discriminate between organic and functional disease of 0.718, and 0.872 to discriminate between irritable bowel syndrome and IBD. CONCLUSION Our study supports the importance of FC as a marker in the evaluation of patients with IBD. The best diagnostic accuracy is obtained at a cut-off value of 150μg/g.
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Affiliation(s)
- Maria Elena Lozoya Angulo
- Servicio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | | | | | | | - Francisco Avilés Plaza
- Servicio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Benítez JM, García-Sánchez V. Faecal calprotectin: Management in inflammatory bowel disease. World J Gastrointest Pathophysiol 2015; 6:203-209. [PMID: 26600978 PMCID: PMC4644884 DOI: 10.4291/wjgp.v6.i4.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/14/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and relapsing disorder which leads to an inflammation of the gastrointestinal tract. A tailored therapy to achieve mucosal healing with the less adverse events has become a key issue in the management of IBD. In the past, the clinical remission was the most important factor to consider for adapting diagnostic procedures and therapeutic strategies. However, there is no a good correlation between symptoms and intestinal lesions, so currently the goals of treatment are to achieve not only the control of symptoms, but deep remission, which is related with a favourable prognosis. Thus, the determination of biological markers or biomarkers of intestinal inflammation play a crucial role. Many biomarkers have been extensively evaluated in IBD showing significant correlation with endoscopic lesions, risk of recurrence and response to treatment. One of the most important markers is faecal calprotectin (FC). Despite calprotectin limitations, this biomarker represents a reliable and noninvasive alternative to reduce the need for endoscopic procedures. FC has demonstrated its performance for regular monitoring of IBD patients, not only to the diagnosis for discriminating IBD from non-IBD diagnosis, but for assessing disease activity, relapse prediction and response to therapy. Although, FC provides better results than other biomarkers such as C-reactive protein and erythrocyte sedimentation rate, these surrogate markers of intestinal inflammation should not be used isolation but in combination with other clinical, endoscopic, radiological or/and histological parameters enabling a comprehensive assessment of IBD patients.
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Boon GJAM, Day AS, Mulder CJ, Gearry RB. Are faecal markers good indicators of mucosal healing in inflammatory bowel disease? World J Gastroenterol 2015; 21:11469-11480. [PMID: 26523111 PMCID: PMC4616222 DOI: 10.3748/wjg.v21.i40.11469] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/19/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the published literature concerning the accuracy of faecal inflammatory markers for identifying mucosal healing.
METHODS: Bibliographical searches were performed in MEDLINE electronic database up to February 2015, using the following terms: “inflammatory bowel disease”, “Crohn´s disease”, “ulcerative colitis”, “faecal markers”, “calprotectin”, “lactoferrin”, “S100A12”, “endoscop*”, “mucosal healing”, “remission”. In addition, relevant references from these studies were also included. Data were extracted from the published papers including odds ratios with 95%CI, P values and correlation coefficients. Data were grouped together according to each faecal marker, Crohn’s disease or ulcerative colitis, and paediatric compared with adult study populations. Studies included in this review assessed mucosal inflammation by endoscopic and/or histological means and compared these findings to faecal marker concentrations in inflammatory bowel diseases (IBD) patient cohorts. Articles had to be published between 1990 and February 2015 and written in English. Papers excluded from the review were those where the faecal biomarker concentration was compared between patients with IBD and controls or other disease groups, those where serum biomarkers were used, those with a heterogeneous study population and those only assessing post-operative disease.
RESULTS: The available studies show that faecal markers, such as calprotectin and lactoferrin, are promising non-invasive indicators of mucosal healing. However, due to wide variability in study design, especially with regard to the definition of mucosal healing and evaluation of marker cut offs, the available data do not yet indicate the optimal roles of these markers. Thirty-six studies published between 1990 and 2014 were included. Studies comprised variable numbers of study participants, considered CD (15-164 participants) or UC (12-152 participants) separately or as a combined group (11-252 participants). Eight reports included paediatric patients. Several indices were used to document mucosal inflammation, encompassing eleven endoscopic and eight histologic grading systems. The majority of the available reports focused on faecal calprotectin (33 studies), whilst others assessed faecal lactoferrin (13 studies) and one study assessed S100A12. Across all of the biomarkers, there is a wide range of correlation describing the association between faecal markers and endoscopic disease activity (r values ranging from 0.32 to 0.87, P values ranging from < 0.0001 to 0.7815). Correlation coefficients are described in almost all studies and are used more commonly than outcome measures such as sensitivity, specificity, PPV and/or NPV. Overall, the studies that have evaluated faecal calprotectin and/or faecal lactoferrin and their relationship with endoscopic disease activity show inconsistent results.
CONCLUSION: Future studies should report the results of faecal inflammatory markers in the context of mucosal healing with clear validated cut offs.
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Kennedy NA, Clark A, Walkden A, Chang JC, Fascí-Spurio F, Muscat M, Gordon BW, Kingstone K, Satsangi J, Arnott ID, Lees CW. Clinical utility and diagnostic accuracy of faecal calprotectin for IBD at first presentation to gastroenterology services in adults aged 16-50 years. J Crohns Colitis 2015; 9:41-9. [PMID: 25135754 PMCID: PMC4795527 DOI: 10.1016/j.crohns.2014.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Distinguishing inflammatory bowel disease (IBD) from functional gastrointestinal (GI) disease remains an important issue for gastroenterologists and primary care physicians, and may be difficult on the basis of symptoms alone. Faecal calprotectin (FC) is a surrogate marker for intestinal inflammation but not cancer. AIM This large retrospective study aimed to determine the most effective use of FC in patients aged 16-50 presenting with GI symptoms. METHODS FC results were obtained for patients presenting to the GI clinics in Edinburgh between 2005 and 2009 from the Edinburgh Faecal Calprotectin Registry containing FCs from >16,000 patients. Case notes were interrogated to identify demographics, subsequent investigations and diagnoses. RESULTS 895 patients were included in the main analysis, 65% female and with a median age of 33 years. 10.2% were diagnosed with IBD, 7.3% with another GI condition associated with an abnormal GI tract and 63.2% had functional GI disease. Median FC in these three groups were 1251, 50 and 20 μg/g (p < 0.0001). On ROC analysis, the AUC for FC as a predictor of IBD vs. functional disease was 0.97. Using a threshold of ≥ 50 μg/g for IBD vs. functional disease yielded a sensitivity of 0.97, specificity of 0.74, positive predictive value of 0.37 and negative predictive value of 0.99. Combined with alarm symptoms, the sensitivity was 1.00. CONCLUSIONS Implementation of FC in the initial diagnostic workup of young patients with GI symptoms, particularly those without alarm symptoms, is highly accurate in the exclusion of IBD, and can provide reassurance to patients and physicians.
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Affiliation(s)
| | - Annalie Clark
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | - Andrew Walkden
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | - Jeff C.W. Chang
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | | | - Martina Muscat
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | - Brydon W. Gordon
- Department of Clinical Biochemistry, Western General Hospital, Edinburgh, UK
| | - Kathleen Kingstone
- Department of Clinical Biochemistry, Western General Hospital, Edinburgh, UK
| | - Jack Satsangi
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | - Ian D.R. Arnott
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | - Charlie W. Lees
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK,*Corresponding author at: Gastrointestinal Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, United Kingdom. Tel.: +44 131 537 1758; fax: +44 131 537 1007;
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Guidi L, Marzo M, Andrisani G, Felice C, Pugliese D, Mocci G, Nardone O, De Vitis I, Papa A, Rapaccini G, Forni F, Armuzzi A. Faecal calprotectin assay after induction with anti-Tumour Necrosis Factor α agents in inflammatory bowel disease: Prediction of clinical response and mucosal healing at one year. Dig Liver Dis 2014; 46:974-9. [PMID: 25096964 DOI: 10.1016/j.dld.2014.07.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Faecal calprotectin levels correlate with inflammation in inflammatory bowel disease. We evaluated the role of faecal calprotectin after anti-Tumour Necrosis Factor α induction in inflammatory bowel disease patients to predict therapeutic effect at one year. METHODS Faecal calprotectin levels were measured in stools of 63 patients before and after induction of anti-Tumour Necrosis Factor α therapy. Clinical activity, measured by clinical indices, was assessed before and after biologic treatment. Clinical responders after induction were included in the study and colonoscopy was performed before and after one year of treatment to assess mucosal healing. RESULTS 63 patients (44 Crohn's disease, 19 ulcerative colitis) were prospectively included (41.2% males, mean age at diagnosis 33 years). A sustained clinical response during the first year was observed in 57% of patients; median faecal calprotectin was 106 μg/g after induction versus 308 μg/g pre-induction (p<0.0001). Post-induction faecal calprotectin was significantly lower in responders versus non-responders (p=0.0002). Post-induction faecal calprotectin had 83% sensitivity and 74% specificity (cut-off ≤ 168 μg/g) for predicting a sustained clinical response at one year (p=0.0001); also, sensitivity was 79% and specificity 57% (cut-off ≤ 121 μg/g) for predicting mucosal healing (p=0.0001). CONCLUSIONS In inflammatory bowel disease faecal calprotectin assay after anti-Tumour Necrosis Factor α induction can be used as a marker to predict sustained clinical response and mucosal healing at one year.
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Affiliation(s)
- Luisa Guidi
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy.
| | - Manuela Marzo
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Gianluca Andrisani
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Carla Felice
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Daniela Pugliese
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Giammarco Mocci
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Olga Nardone
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Italo De Vitis
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Alfredo Papa
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Gianlodovico Rapaccini
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Franca Forni
- Laboratory Diagnostics Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - Alessandro Armuzzi
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
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Smith LA, Gaya DR. Utility of faecal calprotectin analysis in adult inflammatory bowel disease. World J Gastroenterol 2012; 18:6782-9. [PMID: 23239916 PMCID: PMC3520167 DOI: 10.3748/wjg.v18.i46.6782] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/23/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023] Open
Abstract
The inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, are chronic relapsing, remitting disorders. Diagnosis, along with assessment of disease activity and prognosis present challenges to managing clinicians. Faecal biomarkers, such as faecal calprotectin, are a non-invasive method which can be used to aid these decisions. Calprotectin is a calcium and zinc binding protein found in the cytosol of human neutrophils and macrophages. It is released extracellularly in times of cell stress or damage and can be detected within faeces and thus can be used as a sensitive marker of intestinal inflammation. Faecal calprotectin has been shown to be useful in the diagnosis of IBD, correlates with mucosal disease activity and can help to predict response to treatment or relapse. With growing evidence supporting its use, over the last decade this faecal biomarker has significantly changed the way IBD is managed.
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