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P052. Fecal calprotectin is reliable surrogate marker of endoscopic and histologic mucosal healing in Crohn's disease and ulcerative colitis

D. Bojic, B. Bojic, M. Protic, P. Svorcan, V. Gligorijevic, D. Necic, L. Trikos, N. Jojić

Zvezdara University Clinical Center, Belgrade, Serbia

Aims: The main problem in assesing endoscopic and histologic disease activity in Crohn's disease (CD) is discontinous character and transmural nature of CD. In ulcerative colitis (UC) rectal mucosa is not always the “mirror image” of more proximal colonic mucosa. Fecal calprotectin (FCal), as a neutrophil-derived protein, could be surrogate marker of mucosal inflammation and mucosal healing in CD and UC. We evaluated the significance of FCal in CD and UC activity assesment by comparing it with endoscopic activity index (CDEIS/Baron score) and histologic disease activity.

Methods: 124 patients (62 with CD and 62 with UC) were prospectively examined from 2006–2009. Ileocolonoscopy with multiple segmental biopsies was performed in 46 CD and 62 UC patients in remission and when relapsed. Baron score in UC (0 for endoscopicaly quiescent and 3 for severe disease) and CDEIS in CD were calculated (score >3 indicating endoscopicaly active disease). Histological activity was determined according to microscopic inflammation in crypts, enterocytes and lamina propria cellularity and scored (0 for relapse, 3 for the highest degree of inflammation). Every patient provided blood sample for blood count and 2 stool samples, one for FCal measurement (PhiCal Test, Calpro AS, Oslo, Norway) and second for microbiology assay to exclude detectable infection.

Results: CD patients: 30/46 inflammatory, 10 stenosing and 6 penetrating disease. Ileum affected in 32%, colon 31%, ileocolonic 29% and ileum+upper GI tract 8%. CDEIS > 3 was observed in 61% (28/46), histologicaly active disease in 73% (p = 0.064). Median Fcal in remission/relaps was 112±263 and 856±1485 μg/g (p = 0.000), respectively. FCal correlated significantly with CDEIS (r = 0.779, p = 0.000) and histologic CD activity (r = 0.715, p = 0.000). Area under the curve (AUC) for FCal was 0.809 (p = 0.000). Sensitivity, specificity, PPV and NPV for CD FCal concentration at cutoff value of 250 μg/g was 73%, 91%, 93% and 63% in predicting endoscopicaly active disease, and 70%, 83%, 85% and 61% in predicting histologicaly active disease. UC patients: 38/62 (62%) had extensive disease, 21/62 distal and 3/62 proctitis. Baron score >0 observed in 44%, histologicaly active disease in 44%. Median Fcal in remission/relaps was 51±190 and 1653±1530 μg/g (p = 0.000), respectively. FCal correlated significantly with Baron score (r = 0.757, p = 0.000) and histologic activity (r = 0.754, p = 0.000). AUC for UC FCal was 0.912 (p = 0.000). Sensitivity, specificity, PPV and NPV for FCal at cutoff value of 250 μg/g was 88%, 100%, 100% and 64% in predicting endoscopicaly active disease, and 78%, 90%, 89% and 69% in predicting histologicaly active disease.

Conclusion: FCal concentration is sensitive surrogate marker of endoscopic/histologic activity and mucosal healing in CD and UC.