Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery

TLDR: In this analysis of data from a prospective clinical trial, FC measurement has sufficient sensitivity and NPV values to monitor for CD recurrence after intestinal resection and its predictive value might be used to identify patients most likely to relapse.

About: This article is published in Gastroenterology.The article was published on 2015-05-01 and is currently open access. It has received 219 citations till now. The article focuses on the topics: Crohn's Disease Activity Index & Inflammatory bowel disease.

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Table 1. Patient demographics

Table 4. Correlation between fecal calprotectin (FC) and endoscopic recurrence (Rutgeerts score i2 - i4), scored endoscopic severity (score i0 - i4), Simple Endoscopic Score for Crohn’s Disease (SES-CD), Crohn’s Disease Endoscopic Index of Severity (CDEIS), C-reactive protein (CRP) and Crohn’s Disease Activity Index (CDAI).

Table 2 Analysis cohorts and endoscopic recurrence

Table 3. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operator characteristic (AUROC) of fecal calprotectin (FC) in identifying endoscopic recurrence (Rutgeerts ≥i2) at 6 months, 18 months, and combined 6 and 18 months. The calculated best cut-off for FC is shown first in each table.

Frequently asked questions

Q1. What are the contributions in "Measurement of fecal calprotectin improves monitoring and detection of recurrence of crohn's disease following surgery" ?

In this paper, a controlled clinical trial examined different strategies for managing patients after Crohn 's disease resection of all macroscopic disease. 

Q2. What are the future works in "Measurement of fecal calprotectin improves monitoring and detection of recurrence of crohn's disease following surgery" ?

The authors therefore recommend serial measurement of fecal calprotectin at regular intervals in the post-operative period in preference to relying on a single FC measurement to predict future endoscopic behavior. Their findings illustrate the potential value of fecal calprotectin testing routinely in the postoperative setting as part of a management algorithm in asymptomatic patients. These data suggest that FC may have an important role in monitoring Crohn ’ s disease post-operatively, with colonoscopy reserved for those with an elevated calprotectin or those with a clinical indication. Fecal calprotectin measurement may therefore have a further role in monitoring the response to treatment, with colonoscopy reserved for patients who fail to show a fall in calprotectin to within the normal range. 

Q3. What is the significance of the FC level in the study?

In an analysis of data from a prospective clinical trial, measurement of FC has sufficient sensitivity and NPV values to monitor for CD recurrence after intestinal resection. 

Q4. how long did the remission of the colon be predicted?

Six months after surgery, levels of FC<51 µg/g in patients in endoscopic remission predicted maintenance of remission (NPV, 79%). 

Q5. How many patients had matched endoscopic, FC, CRP and CDAI results available?

One hundred and thirty six patients had matched endoscopic, FC, CRP and CDAI results available which were included in a correlation analysis. 

Q6. How can calprotectin be integrated into the post-operative management algorithm?

Calprotectin testing can be integrated into the type of post-operative management algorithm demonstrated in the POCER study to decrease post-operative recurrence. 

Q7. What was the protocol for calprotectin measurement?

As part of the study protocol stool samples were taken pre-operatively (baseline), and at 6,M ANUS CRIP TAC CEPT ED12 and 18 months post-operatively for calprotectin measurement. 

Q8. What is the way to prevent Crohn’s disease recurrence?

10 The PostOperative Crohn’s Endoscopic Recurrence (POCER) study has demonstrated that initial post-operative therapy according to clinical risk of recurrence, with colonoscopy performed six months after intestinal resection and treatment step-up for recurrence, is significantlyM ANUS CRIP TAC CEPT EDsuperior to standard drug therapy alone, in preventing post-operative Crohn’s disease recurrence. 

Q9. What is the effect of endoscopic recurrence?

Endoscopically-identified post-operative disease recurrence occurs early and its severity predicts the subsequent clinical course.