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P403. Normalisation of faecal calprotectin is an absolute marker of mucosal healing and predicts long-term remission in ulcerative colitis (UC)

B. Hayee, P. Dubois, G. Chung-Faye, I. Bjarnason, King's College Hospital NHS Foundation Trust, Gastroenterology, London, United Kingdom

Background

Faecal calprotectin (FCALP) correlates well with the degree of mucosal inflammation in ulcerative colitis (UC). Current disease monitoring strategies usually employ repeated flexible sigmoidoscopy to assess response to therapy. This is costly and may be an unpopular strategy with patients. It is not known whether FCALP offers a reliable alternative. We conducted a retrospective analysis of our institution's practice of using FCALP in monitoring disease activity and response to therapy for UC.

Methods

Electronic records of patients from January 2012 treated for flares of UC (either new or pre-existent disease) were analysed retrospectively. FCALP was measured before and (within acceptable limits): after 8 weeks of therapy with 5ASA or oral tacrolimus; just before the 5th infusion of infliximab; at 8 weeks of adalimumab therapy. Patients were divided into those in whom FCALP normalised (<60 mcg/g) or did not, after these defined time-points. Records were then examined for evidence of symptomatic relapse or a change in therapy (including dose optimisation of anti-TNF). The time from measurement of post-treatment FCALP to relapse or last follow-up was recorded.

Results

47 patients were identified in whom FCALP was measured at appropriate time-points (45.1±14.5 yrs; F=18; E3=28). FCALP normalised in n = 27. The survival curve for relapse-free survival is shown below (median survival 24.0 vs 12.0 weeks, p < 0.01). Normalisation of FCALP at the end of the defined treatment course predicted mucosal healing (Mayo endoscopic score 0) with absolute accuracy (n = 10 to date). hsCRP was normal (<2 mg/l) in 60% of cases, at the beginning of the index treatment episode.

Figure: Kaplan–Meier graphs for time to first relapse after post-treatment FCALP.

Conclusion

Serial measurement of FCALP can replace ‘routine’ flexible sigmoidoscopy for assessment of disease activity. Further, prospective, data are pending to establish the optimum intervals for measurement as well as confirming the relationship to mucosal healing, but normalisation appears to be a powerful predictor of long-term response to treatment.