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P113. Calprotectin for relapse risk assessment in teenagers with inflammatory bowel disease who claim to have full disease control

P. Van Rheenen1

1University Medical Center Groningen, Pediatric Gastroenterology Unit, Groningen, Netherlands

Background: Teenagers with inflammatory bowel disease (IBD) usually have periodic appointments to watch for symptoms that indicate relapse. Multi-item scoring systems are frequently used to measure disease activity, including the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn's Disease Activity Index (PCDAI). PUCAI and PCDAI rely heavily on self-reported parameters and may not be a reliable reflection of the actual inflammatory state. We examined the value of fecal calprotectin to demonstrate preclinical disease activity and predict symptomatic relapse in teenagers who claimed to have full disease control.

Methods: We collected data of 62 consecutive teenagers (31 with Crohn's disease and 31 with ulcerative colitis). Calprotectin, PUCAI or PCDAI, and C‑reactive protein were measured at baseline. Primary outcome was symptomatic relapse within 3 months of baseline, necessitating the introduction of steroids, exclusive enteral nutrition, or an aminosalicylate dose escalation.

Results: The median time since the last relapse was 7 months. Fifteen teenagers (24%) developed symptomatic relapse within 3 months of baseline and 47 (76%) did not. Calprotectin ≥500 µg/g in combination with a PUCAI or PCDAI score indicating mild disease increased the probability of overt symptomatic relapse within 3 months to 60% (95% confidence interval 35–82%). Negative concordant tests reduced the risk of symptomatic relapse to 9% (2–23%).

Conclusions: Periodically measuring calprotectin levels in stool in combination with PUCAI or PCDAI facilitates recognition of preclinical relapse. This would help to identify teenagers requiring treatment intensification at the time of minimal disease rather than at the time of clinically overt relapse. Further studies are warranted to determine the impact of fecal calprotectin testing on treatment management and outcome.

Risk stratification of teenagers with IBD based on the probability of preclinical relapse (“flarometer”).