Fecal calprotectin is a useful marker for defining small bowel endoscopic remission in Crohn’s disease

1. In patients with Crohn’s disease (CD), fecal calprotectin (FC) was a useful biomarker for monitoring small bowel lesions and was correlated with small bowel capsule endoscopy (CE) activity with a cutoff level of 175 μg/g.

Evidence Rating Level: 2 (Good)

Current methods of evaluating small bowel lesions in patients with CD include CE, magnetic resonance enterography and abdominal ultrasonography. However, there remains a lack of standardization in indications for such evaluations and a lack of reliable biomarkers to assess for small bowel disease progression. This prospective cohort study therefore sought to investigate the correlation between FC and small bowel lesions detected by CE in patients with CD. 67 patients (median age[IQR], 27[24-32]; 76% male) with CD from 11 centres in Japan were included in the study and received ileocolonoscopy to rule out active lesions in the large bowel and CE with measurements of their FC. CE activity was assessed using the Lewis Score (LS) and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI). According to severity as determined by the LS, median FC levels for remission were 59.8 μg/g (IQR: 20.1‒140.9), 52.3 μg/g (IQR: 20.8‒577.6) for mild activity, and 446.5 μg/g (IQR: 244.4‒1775.2) for moderate-to-severe activity. The area under the curve (AUC) for the receiver operating characteristic (ROC) curve for endoscopic remission (ER) and FC was 0.828 (95% confidence interval [CI], 0.694‒0.962; P < .001), with a calculated cutoff level of 175 μg/g. Overall, this study found that among patients with CD, FC levels were significantly correlated with small bowel lesions with a cutoff level of 175 μg/g.

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