Association between C-Reactive Protein, Fecal Calprotectin, and Endoscopic Disease Activity in Patients with Inflammatory Bowel Disease — Oak Academic Publishing
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Association between C-Reactive Protein, Fecal Calprotectin, and Endoscopic Disease Activity in Patients with Inflammatory Bowel Disease
Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
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Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
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Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
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Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
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Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
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Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
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Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
1 Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
2 Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
3 Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
4 Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
5 Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
6 Department of Hepato-Gastroenterology, Hassan II University Hospital, Fez, Morocco
7 Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
Background: Endoscopic evaluation is considered the reference method for assessing inflammatory activity in inflammatory bowel disease (IBD) [1] . Nevertheless, the invasive nature and cost of repeated endoscopic procedures limit their use for frequent monitoring in routine clinical practice [2] . In this context, non-invasive biomarkers such as C-reactive protein (CRP) and fecal calprotectin (FC) have been increasingly used to estimate intestinal inflammatory activity [3] . Aim: To examine the relationship between CRP, fecal calprotectin, and endoscopic disease activity in patients with IBD, and to determine the diagnostic performance of their combined use. Methods: This cross-sectional observational study included 180 adult patients with confirmed IBD who underwent recent endoscopic evaluation along with concomitant measurements of CRP and fecal calprotectin. Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn’s Disease (SES-CD) for Crohn’s disease and the Mayo endoscopic subscore for ulcerative colitis. Associations between biomarker levels and endoscopic scores were analyzed using Spearman’s rank correlation coefficient. Results: A total of 180 patients were included, of whom 120 had Crohn’s disease, and 60 had ulcerative colitis. Fecal calprotectin demonstrated strong correlations with endoscopic activity in Crohn’s disease (r = 0.74, p < 0.001) and ulcerative colitis (r = 0.69, p < 0.001). In comparison, CRP showed moderate correlations with endoscopic severity (r = 0.48 and r = 0.42, respectively). The combined evaluation of CRP and fecal calprotectin improved the identification of moderate-to-severe endoscopic inflammation, with a sensitivity of 88% and a specificity of 76%. Conclusion: Fecal calprotectin shows a strong association with endoscopic disease activity and appears to be more informative than CRP for reflecting mucosal inflammation in patients with IBD.
Ng, S.C., Shi, H.Y., Hamidi, N., Underwood, F.E., Tang, W., Benchimol, E.I., et al . (2017) Worldwide Incidence and Prevalence of Inflammatory Bowel Disease in the 21st Century: A Systematic Review of Population-Based Studies. The Lancet , 390, 2769-2778. https://doi.org/10.1016/s0140-6736(17)32448-0
Colombel, J., Narula, N. and Peyrin-Biroulet, L. (2017) Management Strategies to Improve Outcomes of Patients with Inflammatory Bowel Diseases. Gastroenterology , 152, 351-361.e5. https://doi.org/10.1053/j.gastro.2016.09.046
Peyrin-Biroulet, L., Sandborn, W.J., Sands, B.E., Reinisch, W., Bemelman, W., Bryant, R.V., et al . (2015) Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE). Gastroenterology , 148, 1210-1219.
Maaser, C., Sturm, A., Vavricka, S.R., Kucharzik, T., Fiorino, G., Annese, V., et al . (2018) ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial Diagnosis, Monitoring of Known IBD, Detection of Complications. Journal of Crohn ’ s and Colitis , 13, 144-164K. https://doi.org/10.1093/ecco-jcc/jjy113
Vermeire, S., Van Assche, G. and Rutgeerts, P. (2006) Laboratory Markers in IBD: Useful, Magic, or Unnecessary Toys? Gut , 55, 426-431. https://doi.org/10.1136/gut.2005.069476
Henriksen, M., Jahnsen, J., Lygren, I., Stray, N., Sauar, J., Vatn, M.H., et al . (2008) C-reactive Protein: A Predictive Factor and Marker of Inflammation in Inflammatory Bowel Disease. Results from a Prospective Population-Based Study. Gut , 57, 1518-1523. https://doi.org/10.1136/gut.2007.146357
Tibble, J.A., Sigthorsson, G., Foster, R., Forgacs, I. and Bjarnason, I. (2002) Use of Surrogate Markers of Inflammation and Rome Criteria to Distinguish Organic from Nonorganic Intestinal Disease. Gastroenterology , 123, 450-460. https://doi.org/10.1053/gast.2002.34755
Daperno, M., D’Haens, G., Van Assche, G., Baert, F., Bulois, P., Maunoury, V., et al . (2004) Development and Validation of a New, Simplified Endoscopic Activity Score for Crohn’s Disease: The SES-CD. Gastrointestinal Endoscopy , 60, 505-512. https://doi.org/10.1016/s0016-5107(04)01878-4
Schroeder, K.W., Tremaine, W.J. and Ilstrup, D.M. (1987) Coated Oral 5-Aminosalicylic Acid Therapy for Mildly to Moderately Active Ulcerative Colitis. New England Journal of Medicine , 317, 1625-1629. https://doi.org/10.1056/nejm198712243172603
Sherwood, R. and Walsham, N. (2016) Fecal Calprotectin in Inflammatory Bowel Disease. Clinical and Experimental Gastroenterology , 9, 21-29. https://doi.org/10.2147/ceg.s51902
Sipponen, T., Savilahti, E., Kolho, K., Nuutinen, H., Turunen, U. and Färkkilä, M. (2008) Crohnʼs Disease Activity Assessed by Fecal Calprotectin and Lactoferrin: Correlation with Crohnʼs Disease Activity Index and Endoscopic Findings. I nflammatory Bowel Diseases , 14, 40-46. https://doi.org/10.1002/ibd.20312
Schoepfer, A.M., Beglinger, C., Straumann, A., Safroneeva, E., Romero, Y., Armstrong, D., et al . (2010) Fecal Calprotectin Correlates More Closely with Endoscopic Activity than CRP in Ulcerative Colitis. Gut , 59, 151-156.
Mosli, M.H., Zou, G., Garg, S.K., Feagan, S.G., MacDonald, J.K., Chande, N., et al . (2015) C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. American Journal of Gastroenterology , 110, 802-819. https://doi.org/10.1038/ajg.2015.120
Lin, J., Chen, J., Zuo, J., Yu, A., Xiao, Z., Deng, F., et al . (2014) Meta-Analysis: Fecal Calprotectin for Assessment of IBD Activity. Inflammatory Bowel Diseases , 20, 1407-1415. https://doi.org/10.1097/mib.0000000000000057
Gisbert, J.P. and McNicholl, A.G. (2009) Questions and Answers on the Role of Faecal Calprotectin as a Biological Marker in Inflammatory Bowel Disease. Digestive and Liver Disease , 41, 56-66. https://doi.org/10.1016/j.dld.2008.05.008
van Rheenen, P.F., Van de Vijver, E. and Fidler, V. (2010) Faecal Calprotectin for Screening of Patients with Suspected Inflammatory Bowel Disease: Diagnostic Meta-analysis. BMJ , 341, c3369-c3369. https://doi.org/10.1136/bmj.c3369
Lasson, A., Simrén, M., Stotzer, P.O., Öhman, L. and Strid, H. (2015) Fecal Calprotectin Predicts Relapse in Ulcerative Colitis. Inflammatory Bowel Disease , 21, 2341-2347.
Bryant, R.V., Burger, D.C., Delo, J., Walsh, A.J., Thomas, S., von Herbay, A., et al . (2016) Beyond Endoscopic Mucosal Healing in Inflammatory Bowel Disease. Nature Reviews Gastroenterology & Hepatology , 13, 567-578.
Sands, B.E. (2015) Biomarkers of Inflammation in Inflammatory Bowel Disease. Gastroenterology , 149, 1275-1285.e2. https://doi.org/10.1053/j.gastro.2015.07.003
Lewis, J.D. (2011) The Utility of Biomarkers in the Diagnosis and Therapy of Inflammatory Bowel Disease. Gastroenterology , 140, 1817-1826.e2. https://doi.org/10.1053/j.gastro.2010.11.058
Burri, E. and Beglinger, C. (2013) The Use of Fecal Calprotectin as a Biomarker in Gastrointestinal Disease. E xpert Review of Gastroenterology & Hepatology , 8, 197-210. https://doi.org/10.1586/17474124.2014.869476
Mosli, M.H., Feagan, B.G., Zou, G., Sandborn, W.J., D’Haens, G., Khanna, R., et al . (2015) Reproducibility of Fecal Calprotectin Measurements. Inflammatory Bowel Disease , 21, 2211-2217.
Lasson, A., Öhman, L., Stotzer, P.O., Simrén, M. and Strid, H. (2013) Monitoring Ulcerative Colitis with Fecal Calprotectin. Scandinavian Journal of Gastroenterology , 48, 1133-1138.
Schoepfer, A.M., Trummler, M., Seeholzer, P., Seibold-Schmid, B. and Seibold, F. (2008) Discriminating IBD from IBS: Comparison of the Test Performance of Fecal Markers, Blood Leukocytes, CRP, and IBD Antibodies. Inflammatory Bowel Diseases , 14, 32-39. https://doi.org/10.1002/ibd.20275
Kostas, A., Siakavellas, S.I., Kosmidis, C., Takou, A., Nikou, J., Maropoulos, G., et al . (2015) Fecal Calprotectin in Inflammatory Bowel Disease. Annals of Gastroenterology , 28, 1-8.
Peyrin-Biroulet, L., Loftus, E.V., Colombel, J. and Sandborn, W.J. (2010) The Natural History of Adult Crohn’s Disease in Population-Based Cohorts. American Journal of Gastroenterology , 105, 289-297. https://doi.org/10.1038/ajg.2009.579
DʼHaens, G., Ferrante, M., Vermeire, S., Baert, F., Noman, M., Moortgat, L., et al . (2012) Fecal Calprotectin Is a Surrogate Marker for Endoscopic Lesions in Inflammatory Bowel Disease. Inflammatory Bowel Diseases , 18, 2218-2224. https://doi.org/10.1002/ibd.22917
Kennedy, N.A., Jones, G.R., Lamb, C.A., Appleby, R., Arnott, I., Beattie, R.M., et al . (2019) British Society of Gastroenterology Guidance for IBD Management. Gut , 68, S1-S106.
Turner, D., Ricciuto, A., Lewis, A., D’Amico, F., Dhaliwal, J., Griffiths, A.M., et al . (2021) STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target Strategies in IBD. Gastroenterology , 160, 1570-1583. https://doi.org/10.1053/j.gastro.2020.12.031
Ungaro, R., Mehandru, S., Allen, P.B., Peyrin-Biroulet, L. and Colombel, J. (2017) Ulcerative Colitis. The Lancet , 389, 1756-1770. https://doi.org/10.1016/s0140-6736(16)32126-2
Singh, S., Ananthakrishnan, A.N., Nguyen, N.H., Cohen, B.L., Velayos, F.S., Weiss, J.M., et al . (2023) AGA Clinical Practice Guideline on the Role of Biomarkers for the Management of Ulcerative Colitis. Gastroenterology , 164, 344-372. https://doi.org/10.1053/j.gastro.2022.12.007
Clough, J., Colwill, M., Poullis, A., Pollok, R., Patel, K. and Honap, S. (2024) Biomarkers in Inflammatory Bowel Disease: A Practical Guide. Therapeutic Advances in Gastroenterology , 17. https://doi.org/10.1177/17562848241251600