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* = Presenting author

P236 Faecal calprotectin is a poor predictor of irritable bowel disease relapse during pregnancy

S. Kanis*, A. de Lima, V. van Oorschot, C. van der Woude

Erasmus Medical Centre, Gastroenterology and Hepatology, Rotterdam, Netherlands

Background

During pregnancy, clinical parameters for disease activity are often difficult to interpret due to hormonal changes and altered bowel motility, further CRP is often elevated during pregnancy and increases in the third trimester of pregnancy. Faecal calprotectin (FCP) is a leukocyte- derived protein that is increasingly used as biomarker to monitor IBD patients. The aim of this study is to assess whether FCP is predictive for disease relapse in pregnant patients with inflammatory bowel disease (IBD).

Methods

Female IBD patients visiting our preconception outpatient clinic between July 2008 and May 2015 were prospectively enrolled. Patients were seen every 3 months before and bimonthly during pregnancy. During visits disease history, medication use, life style factors and pregnancy course were recorded. Additionally, blood and stool samples for FCP were obtained. Disease activity was based on clinical assessment by treating physician based on HBI (> 5 for CD) and SCCAI (>2 for UC), CRP and if needed endoscopy. A FCP > 200ug/g was considered increased.

Results

In total, 75 women were included, accounting for 76 pregnancies (53 CD [69.8], 20 UC [26.3], 3 IBDU [3.9]), and women were still pregnant. In first, second, and third trimester, respectively 52, 68, and 64 stool samples for FCP were obtained. An increased FCP was seen in 15(28.8%) pts in first trimester, in 25 (36.8%) pts in the second trimester, and in 23 (35.9%) pts in third trimester. Disease activity was identified by the treating physician in 12(23.1%) pts during the first, 15(22.1%) pts during second, and 17 (26.6%) pts during third trimester. The overall sensitivity of FCP to diagnose disease relapse was 81.8%, and the overall specificity was 80.7%.

Further, we assessed whether FCP could predict disease relapse in the follow-up during pregnancy and we were not able to show any correlation between an elevated FCP and a subsequent disease relapse. In case pts had an isolated FCP > 200 ug/g without disease activity, pts were not treated for disease relapse. This was the case in 6 pts during the first trimester (median FCP 315 ug/g [IQR 315.3–646.3]), and none relapsed in the subsequent trimester. In the second trimester, there were 12 pts with an isolated increased FCP (median 409ug/g [IQR 278–592]). In the subsequent trimester, 2 pts relapsed, 7 pts did not, and 3 pts were still in follow-up. In the third trimester, 7 pts had an isolated increased FCP (median 347 ug/g [IQR 255–540]). Finally, 1 pt relapsed post-partum, 3 pts did not relapse, and 3 were still in follow-up.

Conclusion

This prospective cohort study in pregnant IBD women shows an overall high sensitivity and specificity of FCP in the occurrence of disease activity, respectively, 81.8% and 80.7%. However, the predictive value of FCP for disease relapse during pregnancy is poor.