Calprotectin in Daily Practice: Where Do We Stand in 2017?

Abstract

Background: To make a distinction between organic and functional disease is essential for gastroenterologists in their daily practice, but it may be challenging, given the variety and aspecificity of gastrointestinal symptoms among the general population. The clinician aim is to avoid diagnostic delay and to restrict unnecessary invasive and expensive exams. Summary: Faecal markers, in particular faecal calprotectin (FC), have given proof of being reliable markers of intestinal inflammation with good clinical sensitivity. Calprotectin is useful in the differential diagnosis between inflammatory bowel disease and irritable bowel syndrome, as well as in the follow-up of inflammatory bowel disease patients and in predicting treatment response, with an excellent correlation with endoscopic activity. Its role in collagenous colitis and infectious colitis is less clear and still under investigation. Key Message: Despite the growing evidence supporting its use, many clinicians are uncomfortable in dosing FC, due to its low specificity and the variability of cut-off values. Indeed there are no clear guidelines about how to manage patients with intermediate levels of FC. The aim of this article is to review recent literature on calprotectin and its use. The strong points and the limits of FC measurement will be analysed, and a practical approach in the daily clinical routine will be proposed.

Association of fecal calprotectin concentrations with disease severity, response to treatment, and other biomarkers in dogs with chronic inflammatory enteropathies

“…These findings are in line with our previous investigations showing calprotectin concentrations to be increased in serum from dogs with SRE/IRE compared to healthy dogs and also in pretreatment fecal samples from dogs with SRE/IRE compared to healthy controls . Measuring higher fecal calprotectin concentrations in dogs with SRE/IRE is also consistent with studies in human medicine showing that increased fecal calprotectin concentrations can identify dogs with active IBD from either non‐IBD controls or IBD dogs in remission, and is also similar to the results reported for fecal S100A12 concentrations in dogs . The current study suggests that a pretreatment fecal calprotectin concentration of ≥15.2 μg/g might signal the need for more aggressive (ie, immunosuppressive, anti‐inflammatory, or both) treatment in CIE dogs, but a combination with serum CRP, CCECAI score, or both yielded a higher diagnostic accuracy.…”

Irritable Bowel Syndrome-Like Symptoms in Ulcerative Colitis Patients in Clinical Remission: Association with Residual Colonic Inflammation

“…Since infiltration of neutrophils during intestinal inflammation results in the release of calprotectin in stools, termed FC, its level is well correlated to mucosal activity in UC patients [39][40][41][42][43]. In particular, FC level is considered to be an effective surrogate marker for evaluating mucosal healing in UC patients in clinical remission [44,45].…”

Correlation of Fecal Markers with Magnifying Endoscopic Stratification in Patients with Ulcerative Colitis Who Are in Clinical Remission

“…Fecal markers such as calprotectin, lactoferrin, and hemoglobin have been reported to correlate well with the Mayo endoscopic subscore (MES) and are being considered alternative monitoring tools in endoscopy [4-8]. Calprotectin is a calcium-binding protein and accounts for up to 60% of cytoplasmic proteins in neutrophils [6], and is mainly derived from neutrophils.…”