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P096. Limitations of fecal calprotectin at diagnosis in untreated pediatric Crohn's disease

R. Shaoul1, D. Turner2, M. Sladek3, G. Veres4, G. Veerman-Wauters5, J. Escher6, A. Paerregaard7, J. Amil Dias8, P. Lionetti9, A. Levine10

1Rambam Medical Center, Pediatric Gastroenterology, Haifa, Israel; 2Shaare Zedak Medical Center, Pediatric Gastroenterology Unit, Jerusalem, Israel; 3American Hospital Krakow, Poland; 4Dr. Veres Medaker Bt, Monor, Hungary; 5University Hospital UZ, Belgium; 6Erasmus MC-Sophia Children's Hospital, Netherlands; 7H:S Hvidovre Hospital, Denmark; 8Hospital, S. Joao, Porto, Portugal; 9Meyer Children's hospital, Florence, Italy; 10Wolfson Medical Center, Tel Aviv University, Pediatric Department, Holon, Israel

Background: Fecal Calprotectin (FC) is a validated screening test for intestinal inflammation in Crohn's disease (CD). The objective of the study was to prospectively evaluate the limitations of FC for identifying CD in newly diagnosed untreated pediatric patients and to assess the association of FC levels with disease location and serum inflammatory markers.

Methods: The Growth, Relapse and Outcomes with Therapy in CD (GROWTH) study is a prospective pediatric trial performed by the European Pediatric Porto group aimed at evaluating predictors as well as biomarkers for outcomes in Pediatric CD. Children <17 years of age were enrolled at disease onset. Consecutive children with new onset untreated CD were evaluated at diagnosis for disease activity, extent, C‑reactive protein (CRP), and FC.

Results: In all, 60 children met the inclusion criteria (mean age 12.6 6 4.6 years), 25 (42%) with mild disease, 17 (28%) moderate disease, and 18 (30%) severe disease. Twenty-seven (45%) had small bowel disease only. Median FC levels did not differ between children with small bowel only (2198 lg/g interquartile range [IQR] 696–2400) and those with colonic involvement (with or without small bowel disease; 2400 lg/g (IQR 475–2400) (P = 0.76). FC was elevated in 95% of patients, in comparison to CRP (86%) and erythrocyte sedimentation rate (ESR) (83%). Three children (5%) who had normal calprotectin levels also had low or normal CRP and/or ESR. There was no correlation between calprotectin levels and either the pediatric CD activity index (r = −0.11; P = 0.94) or physicians global assessment.

Conclusions: FC levels in active disease confined to the small bowel were elevated in the vast majority of children and site of disease was not a confounding factor in this setting. Patients with low FC had a trend toward low levels of inflammatory markers as well. We did not find a significant correlation between FC and clinical indices of activity.