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

Abstract

Background: Maintenance of mucosal healing is recommended during the treatment of ulcerative colitis (UC). However, symptoms of UC often do not reflect mucosal disease activity. 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. Ulcerative Colitis Endoscopic Index of Severity (UCEIS) is a new and more detailed endoscopic scoring system compared to MES. Furthermore, magnifying endoscopic stratification (ME) based on alterations in the mucosal surface pit patterns is noted in UC. However, the association between fecal markers and UCIES and magnifying endoscopy is relatively unexplored. Summary: This study investigated the association between the aforementioned fecal markers and MES, UCEIS, and ME in patients with UC in clinical remission. This prospective study included 60 patients with UC in clinical remission who underwent colonoscopy at the Nagasaki University Hospital between June 2015 and November 2016. A significant correlation was observed between MES and all fecal markers. Notably, the fecal markers correlated well with UCEIS (calprotectin Spearman’s correlation coefficient [r] = 0.54, p < 0.0001; lactoferrin r = 0.56, p < 0.0001; and hemoglobin r = 0.43, p < 0.001). Furthermore, ME findings correlated significantly with calprotectin (r = 0.50, p = 0.0002) and lactoferrin (r = 0.46, p = 0.0006) levels and slightly with hemoglobin (r = 0.28, p = 0.043) levels. Moreover, each cutoff level of fecal calprotectin, lactoferrin, or hemoglobin had a high sensitivity and specificity for the detection of MES = 0, UCEIS = 0, ME = A, for predicting mucosa healing. Key Messages: Fecal markers correlated not only with MES but also with UCEIS and ME and should be useful for monitoring patients with UC in clinical remission.

Positive fecal immunochemical test results are associated with non-colorectal cancer mortality

“…Systemic inflammation caused by these diseases may lead to subclinical gut inflammation and consequent occult bleeding. This hypothesis is supported by recent studies in which f-Hb was reported to be a useful marker of gut inflammation in patients with ulcerative colitis in clinical remission [23,24]. In addition, systemic inflammation has been reported to be associated with mortality.…”

Occult blood in faeces is associated with all-cause and non-colorectal cancer mortality

“…Therefore, it may be that the increased risk of colonic adenoma in the gFOBT positive population is due to generalised colonic inflammation rather than bleeding from the adenomas themselves. This concept is supported by recent work on mucosal healing in inflammatory bowel disease, in which f-Hb has been found to be a better marker than the more traditional measure of gut inflammation, faecal calprotectin 19 20…”

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].…”