P134. Is faecal calprotectin a useful marker of postoperative recurrence in Crohn's ileal disease?
M.T. Herranz1, R. Ruiz-Zorrilla1, N. Alcaide1, M.A. Mazón1, S. Lorenzo1, L. Sancho1, P. Gil Simon1, R. Atienza1, J. Barrio1
1Rio Hortega University Hospital, Gastroenterology Department, Valladolid, Spain
Background: Endoscopic evidence of recurrence of Crohn's disease is up to 80% during the first year after surgery and by 3 to 5 years later, a third part of these patients will present a clinical relapse. The aim of this study is to evaluate the utility of faecal calprotectin as a marker of recurrence in patients with Crohn's ileal disease who have undergone previous surgical resection.
Methods: An observational study which included all patients with Crohn's ileal disease who had ileal and ileocolonic resection, followed up in an inflammatory bowel disease unit of a tertiary center. Endoscopic evidence of recurrence (ER) is defined as Rugeerts index modified >i2A; clinical relapse (CR) as Harvey index >6. In all the cases the levels of faecal calprotectin (Calprest), CPR and ESR were determined in the days previous to endoscopy.
Results: Initially, 55 patients were included, but finally 4 were excluded; 2 because inclomplete endoscopy and 2 due to signs of colonic activity. Of the 51 remaining patiens (57% males), 41% were active smokers, 65% were being treated with thiopurines to prevent the recurrence and 17.7% received anti‑TNF treatment (alone or in combination with tiopurines). At the moment of their inclusion in the study 33% of the patients presented CR.
70% of the patients with CR (Harvey >6) had amounts of fecal calprotectin >100, this without statistical significance. There was a progressive increase of the values of faecal calprotectin in relation to the increase in Rugeerts index where p = 0.05. The correlation between faecal calprotectin and ER was 0.437 (p < 0.001). The area below the ROC curve was 0.72 (CI 0.570.86) with a significance of 0.007. A value of 100 mg/kg of calprotectin has a sensitivity of 76% (CI 5794) a specificity of 61% (CI 4082), positive predictive value of 65% (CI 4684), negative predictive value of 72% (CI 5193) for the diagnosis of ER.
Conclusions: Faecal calprotectin has a weak correlation with recurrence in Crohn's ileal diseas, either endoscopic or clinical. Therefore its utility in patients with a Crohn's ileal disease and previous resection is limited. High amounts of faecal calprotectin could help us suspect a recurrence but other complementary tests would still be necessary in order to determinate the degree of recurrence.