Publication of the Month – Progress in search for IBD relapse prediction

Last updated: 18th April, 2019

Title: Can faecal calprotectin predict relapse in inflammatory bowel disease: a mini review
Author: Chew TS, Mansfield JC
Journal: Frontline Gastroenterology 2018;9:23-28 doi:10.1136/flgastro-2016-100686

Fecal calprotectin (FC) is an indicator of inflammation, elevated levels are indicative of any of the different patterns of mucosal inflammatory activity which are a feature of inflammatory bowel disease (IBD). Changes in fecal calprotectin levels may be more predictive of a relapse than absolute values.

The review has retrospectively analysed 17 studies looking at FC levels in relapsing and remission groups of patients with IBD.  The definitions of relapse vary considerably among the papers cited and, as can be seen from the cut-offs used, many different methods for quantifying FC have been used. Sensitivity for detecting a defined relapse ranged from 31% to 100% while the specificity went from 43% to 100%.  The majority of studies found a significantly higher baseline FC level in patients who subsequently relapsed compared with those who did not.  In an ongoing study, fecal marker of intestinal inflammation for relapse prediction in routine monitoring of patients with CD (FIRE), has similar findings but also reflects the difficulty of using FC to predict relapse in a multifaceted disorder as CD.  In using FC to detect postoperative recurrence in CD, several papers have found a correlation between FC levels and disease recurrence as well as a lowering of FC levels in patients with reduced or absent symptoms postoperatively.  A publication by Wright et al. showed that increasing treatment in patients with endoscopic recurrences resulted in a reduction of FC levels at 12 and 18 months.

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