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* = Presenting author

P412 Fecal calprotectin as predictor of relapse in asymptomatic Ulcerative Colitis

E. Leo Carnerero*, G. Ontanilla Clavijo, C. Trigo Salado, V. Aguilera Jaldo, M.D. De La Cruz Ramirez, A. Araujo Miguez, J.M. Herrera Justiniano, J.L. Marquez Galan

HU Virgen del Rocío, UGC Digestive Diseases, Seville, Spain

Background

To assess the predictive ability of relapse of fecal calprotectin (CF) in asymptomatic ulcerative colitis (UC) patients.

Methods

Retrospective analysis of UC patients with a FC assay done being asymptomatic. Patients with clinical activity within the 6 months prior to the FC assay were not included, as well as those who needed a treatment change in the previous three months.

Variables collected included demographic characteristics, tobacco use, phenotype UC according to Montreal's classification and the levels of FC (mcg/gr). We perform an analysis of the clinical course of the disease after a 12 months clinical follow-up period, considering a significant clinical relapse in those who required treatment changes to control the new onset symptoms.

Results

We included 101 patients (56 men, 45 women). Mean age at diagnosis was 33,03 ± 15,73 years (2-78y); 15 (14,9%) were smokers. Extensive colitis was found in 62,4% of patients, 34,7% had left colitis and 3% proctitis. Mean value of FC was 182,4 ± 237,47 mcg/g (1,3 - 1135).

During the next 12 months following the FC assay, 28 patients (27,7%) suffer a relapse of the disease; 14 of those requiring only a dose increase of salicylates, 4 treated with steroids and 10 needing both jointly.

FC value was higher in patients who required treatment modification (314,45 ± 283,37 vs 131,79 ± 197,05; p 0,001); 80,8% of those patients with FC less than 200 mcg/g maintained asymptomatic in the next year of follow-up, whereas when FC was higher than this threshold only the 50% kept asymptomatic in that same period of time (p 0,002). A FC level lower than 200 mcg/gr appears as a protective factor against clinical relapse during the next year follow up (odds ratio 0,384(IC-95% 0,211-0,698)).

No significant differences were found in the mean FC level regarding the type of treatment modification needed, being 278,10 ± 309,09 mcg/g for patients requiring only dose increase of salicylates and 399,65 ± 288,09 mcg/g for those treated with steroids (p 0,792). No relation was found between sex, tobacco use and UC characteristics and the risk of clinical relapse.

Conclusion

FC values lower than 200 mcg/g in asymptomatic UC patients predict a good course of the disease within the next year follow-up, whereas higher levels imply a 50% incidence of relapse. Probably histologically active disease without endoscopic or clinical impact may explain the low positive predictive value of higher FC levels.