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P227 Association between pouchitis and faecal calprotectin following restorative proctocolectomy in patients with ulcerative colitis

A. Fujimori*1,2, M. Uchino2, H. Ikeuchi2, T. Masaki1

1Kagawa University, Department of Gastroenterology and Neurology , Faculty of Medicine, Takamatsu, Japan, 2Hyogo collage of Medicine, Department of Inflammatory Bowel Disease , Division of surgery, Nishinomiya, Japan

Background

Recently, faecal calprotectin has been shown to be a useful assessment tool for confirmation of disease activity in ulcerative colitis. On the other hand, few reports have suggested its usefulness for prediction and assessment of pouchitis. There is lack of sufficient evidence whether the faecal calprotectin is more useful for diagnosis of pouchitis or not than ordinal clinical, endoscopic, and histological diagnostic procedures.

We prospectively examined faecal calprotectin during pouchoscopy and analysed the association with pouchitis.

Methods

Patients who underwent a pouchoscopy following a total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis were analysed regardless of symptoms suspicious of pouchitis. Faecal samples were collected for measurement of calprotectin during the pouchoscopy. Pouchitis was determined when the modified-pouchitis disease activity index (m-PDAI) score was ≥5. The associations of development of pouchitis with m-PDAI score, faecal calprotectin, and serum markers, including C-related protein (CRP), erythrocyte sedimentation rate (ESR), albumin (Alb), and white blood cell (WBC) count, were examined.

Results

A total of 24 patients were enrolled, of whom 14 were diagnosed with pouchitis, with a median m-PDAI score of 7.5 (range 5–11). The median value for faecal calprotectin was 1395 μg/g (44.9–7730 μg/g) in patients with and 98.1 μg/g (12.2–1580 μg/g) in those without pouchitis (p < 0.01). The correlation coefficient between calprotectin and m-PDAI score showed a significant association (r = 0.565, p = 0.004). The cut-off value for faecal calprotectin level in ROC analysis was 494 μg/g [area under the curve (AUC) 0.84, sensitivity 78.6%, specificity 90.0%], and the correlation coefficient between ESR and m-PDAI score also indicated a significant association (r = 0.514, p = 0.01). The cut-off-value for faecal calprotectin in ROC analysis was 494 (AUC 0.821, sensitivity 71.43%, specificity 90.0%), while no significant association was found for the other examined markers (CRP: r = 0.284, p = 0.17; WBC: r = 0.333, p = 0.11; Alb: r = 0.257, p = 0.225). The cut-off values for those other markers were 0.32 mg/dl (AUC 0.7785, sensitivity 85.7%, specificity 70%), 7100 (AUC 0.557, sensitivity 57.14%, specificity 70%), and 3.8 g/dl (AUC0. 6857, sensitivity 50%, specificity 90%), respectively.

Conclusion

Elevated faecal calprotectin appears to have a significant correlation with development of pouchitis. We need to clarify the alterations of the concentration of faecal calprotectin during treatment in the further study.