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P478. Feasibility and utility of a lactoferrin twice weekly monitoring in patients with ulcerative colitis

J. Langhorst1, M. Schöls1, A. Rüffer2, G.J. Dobos3, J.H. Boone4, 1University Duisburg-Essen, Kliniken Essen-Mitte, Integrative Gastroenterology, Essen, Germany, 2Labor L+S, Enterosan, Bad Bocklet-Großenbrach, Germany, 3University Duisburg-Essen, Kliniken Essen-Mitte, Internal and Integrative Medicine, Essen, Germany, 4TechLab Inc., Virginia, Blacksburg, United States

Background

It is known that approx. one third of patients with ulcerative colitis in remission present with acute symptoms of irritable bowel syndrome. Hence, to distinguish IBS symptoms from active disease on an every-day basis has a crucial impact on treatment decision and might save patients from relevant side effects. Fecal biomarkers like lactoferrin and calprotectin have been proposed as potential tools for long-term monitoring of IBD patients for identifying presence of intestinal inflammation and for predicting a flare. However, information on the weekly variation in levels due to lifestyle, medication and diet changes over an extended period of time (>6 months) is lacking.

Aim: In this study, we evaluated lactoferrin levels of UC patients in stool samples collected twice weekly for a target period of 1 year.

Methods

Ulcerative colitis (UC) patients in sustained remission sampled twice weekly in their home environment and sent the samples to the reference lab in a pre-prepared fashion. Fecal lactoferrin was determined quantitatively using an ELISA (IBD-SCAN; ≥7.25 µg/g). Clinical symptoms were assessed using the CAI (<5 defining clinical remission) on a monthly basis and in the event of a clinical flare reported by the patients. Baseline and assessments of an acute flare included CAI, endoscopy and biopsy for Mayo and Riley histopathology scores.

Results

A total of 642 fecal specimens were collected over a mean period of 33.5 weeks (range 18 to 40) in 10 UC patients (8male; mean age: 56.2±13.1) with Mayo scores ≤1. Maintenance medications include mesalazine (6), herbal (1), and none (3). Mean lactoferrin for each patient ranged from 2 to 12 with standard deviation (SD) ranging from 3 to 6. CAI ranged from 0 to 4 with SD ranging from 0 to 3.4. During the reported monitoring interval, 20% of patients experienced symptoms fulfilling the clinical criteria of an acute flare with CAI 6 and 9. However, fecal lactoferrin was baseline for both patients indicating no intestinal inflammation. Endoscopy and histological examination ruled out acute inflammation and supported symptoms of acute IBS in both cases. The escalation of the anti-inflammatory treatment could be prevented.

Conclusion

Intense monitoring with fecal lactoferrin twice a week is feasible and shows promise for long-term monitoring of UC patients as an aid for differentiating active IBD from IBS for optimizing treatment.