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Fecal Calprotectin and the Clinical Activity Index Are Both Useful to Monitor Medical Treatment in Patients with Ulcerative Colitis

Burri, Emanuel ; Beglinger, Christoph ; von Felten, Stefanie ; Lehmann, Frank

In: Digestive Diseases and Sciences, 2015, vol. 60, no. 2, p. 485-491

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    Title
    • Fecal Calprotectin and the Clinical Activity Index Are Both Useful to Monitor Medical Treatment in Patients with Ulcerative Colitis
    Author
    • Burri, Emanuel. Department of Gastroenterology, University Medical Clinic, Cantonal Hospital, Rheinstrasse 24, 4410, Liestal, Switzerland
    • Beglinger, Christoph. Department of Gastroenterology and Hepatology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • von Felten, Stefanie. Clinical Trial Unit, University Hospital, Schanzenstrasse 55, 4031, Basel, Switzerland
    • Lehmann, Frank. Department of Gastroenterology and Hepatology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Digestive Diseases and Sciences, 2015, vol. 60, no. 2, p. 485-491. Springer US; http://www.springer-ny.com
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:332297
    Summary
    Background: Non-invasive monitoring of inflammatory bowel disease is an unmet clinical need as patients in clinical remission may have residual mucosal inflammation preceding clinical relapse. Aims: We aimed to assess the value of fecal calprotectin and standardized clinical activity scoring to monitor disease activity in ulcerative colitis under medical treatment. Methods: Forty-one patients with ulcerative colitis were included in a prospective observational study. Medical treatment was guided by clinical judgement of treating physicians. Fecal calprotectin and the clinical activity index (CAI) were measured blinded to treating physicians every 2months until the end of follow-up. Twenty-six patients received colonoscopy for clinical reason. Results: As defined by the CAI, patients were in clinical remission (63.4%), having mild (26.8%) or moderate (11.2%) disease activity. Of those in clinical remission (CAI≤4), 86.4% showed residual endoscopic activity (Mayo Score ≥1). Calprotectin levels were higher in endoscopically active disease (779.0 vs 331.5μg/g, P=0.034) and calprotectin testing identified more patients with endoscopic disease activity (86.4%) than the CAI (45.5%, P=0.034). Medical treatment was escalated in 90.2% during the study. Values of the CAI and calprotectin correlated with therapy escalation (OR 3.94 and 3.22, respectively). Only for calprotectin, changes between two measurements were related to intensified medical treatment (OR 1.39). Conclusion: Fecal calprotectin was similarly useful to the CAI to monitor disease activity of ulcerative colitis during medical treatment but identified endoscopic disease activity far more reliably. Changes of calprotectin values between measurements might indicate clinical relapse earlier than the CAI.