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

Abstract

Although CRP, FC, and SL are useful biomarkers, their value in managing individual patients must be considered in specific clinical contexts.

Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohn’s disease with fecal calprotectin

“…Along these lines, Lin et al (20) published a meta-analysis on FC accuracy in order to detect endoscopic activity, and Mosli et al (4) have recently published a meta-analysis on the accuracy of C-reactive protein, FC and fecal lactoferrin to detect endoscopic activity in IBD patients. Both studies observed considerable heterogeneity between the various tests due to a lack of diagnostic methodology standardization as there are so few studies evaluating endoscopic activity.…”

“…Likewise, the cut-off point is still not clearly defined for mucosal healing although some recent studies have opted for SES-CD ≤ 2 (9,10). If we also consider that colonoscopy for monitoring inflammatory activity can be complicated, then it is appropriate to identify and develop non-invasive biomarkers by producing evidence that shows that fecal biomarkers, in particular fecal calprotectin (FC), are a more accurate tool for predicting inflammatory activity in CD than blood tests (4). Such biomarkers include M2 pyruvate kinase (M2-PK), an enzyme that is expressed by continually replicating cells, such as intestinal mucus cells.…”

“…The assessment of symptoms has not proved to be useful in accurately establishing endoscopic activity despite the availability of instruments such as the Crohn's disease activity index (CDAI) (2). Since the main aim of treatment is to achieve mucosal healing (3), we need to base clinical criteria on tests that provide us with accurate and objective data to show the resolution or persistence of inflammatory activity in CD (4).…”

“…Ileo-colonoscopy with a biopsy is considered to be the "gold standard" for assessing intestinal inflammation, yet it is costly, not widely available and can cause complications (4)(5)(6). Although a series of specific endoscopic indices have been developed, such as the Crohn's Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn's Disease (SES-CD), which can classify degrees of activity and correlate to a considerable degree (7), they are difficult to calculate and interpret in daily medical practice, although the SES-CD is simpler and easier to use (8).…”

Optimization of anti-TNF therapy in patients with Inflammatory Bowel Disease

“…Moreover, fecal calprotectin is often used as a surrogate marker to assess disease activity in our outpatient clinic as it has been shown that there is a high correlation between fecal calprotectin and endoscopic disease activity in IBD patients. [72,103] The ultimate goal of all these strategies is to discontinue ineffective or unnecessary treatment, improve treatment efficacy and reduce side-effects of anti-TNF therapy.…”