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P222. Fecal calprotectin as a marker of severity of mucosal involvement in children with inflammatory bowel disease

J. Dolinsek1, P. Riznik2, L. Sabath2, D. Micetic-Turk2, 1University Medical Centre, Gastroenterology Unit, Department of Paediatrics, Maribor, Slovenia, 2Medical Faculty, University of Maribor, Department of Paediatrics, Maribor, Slovenia

Background

Inflammatory bowel disease (IBD) in children has a remittent course with episodes of remission followed by deterioration and different degree of mucosal inflammation.

The aim of our study was to evaluate the value of fecal calprotectin, C-reactive protein and clinical scores in prediction of endoscopic and histological lesions in children with IBD treated at Pediatric Gastroenterology Department of University Medical Centre Maribor.

Methods

28 children (mean age 14.2 years; female 14) with IBD confirmed according to Porto criteria were included in the study. There were 15 patients with ulcerative colitis (UC) and 13 with Crohn's disease (CD).

We retrospectively reviewed clinical scores, CRP values, endoscopic and histological data as well as fecal calprotectin values in all included children. The severity of mucosal inflammation was assessed using endoscopic and histological scores. The disease activity index was calculated using PUCAI and PCDAI respectively. Fecal calprotectin concentration was measured by enzyme-linked immunosorbent assay (ELISA) using commercially available kit (Calprest, Eurospital, Trieste, Italy). Correlation of observed parameters was analyzed with SPSS for Windows.

Results

Fecal calprotectin showed high correlation with histological lesions (r = 0.713, p ≤ 0.01) and with endoscopical lesions (r = 0.601, p < 0.05) in children with UC. Correlation between histological lesions and PUCAI (r = 0.567, p ≤ 0.05) or CRP (r = 0.446; n.s.) was lower. Low correlation was also found for endoscopy scores (PUCAI: r = 0.342, n.s.; CRP: r = 0.334, n.s.).

Same parameters were compared in children with CD. Histological lesions and calprotectin did not correlate as well as in UC (r = 0.429). Almost identical results were found for CRP (r = 0.431), and much lower for PCDAI (r = 0.185). Regarding endoscopy and calprotectin, correlation was lower than in children with UC (r = 0.417), and correlation with PCDAI (r = 0.180) or CRP (r = 0.221) was even lower. Statistical significance for any of the observed parameters in CD patients was not found (p > 0.05).

Conclusion

Based on the results of our study, we conclude that a better prediction of the severity of endoscopic and histological lesions can be achieved by determination of fecal calprotectin compared to CRP and disease activity scores. This was shown especially for patients with ulcerative colitis.

Fecal calprotectin as a noninvasive marker could possibly be used to reduce the number of endoscopic procedures in children with confirmed diagnosis of IBD.