Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohn’s disease

Abstract

Background and aims:Capsule endoscopy is an extended tool for the diagnosis of small bowel Crohn's disease. However, factors associated with positive findings of this technique have not been well established. Our aim is to asses which factors are associated with a better diagnostic yield of capsule endoscopy in suspected small bowel Crohn's disease.Material and methods: This was a retrospective study including patients under capsule endoscopy because of suspected small bowel Crohn's disease. Demographic data of these patients, as well as symptoms and laboratory data including hemoglobin levels, count of leucocytes and platelets, and levels of C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin were collected. Capsule endoscopy studies were classified as negative (no lesions) or positive (lesions suggestive of Crohn's disease). Descriptive, univariate and multivariate analysis were done, as well as diagnostic yield tests of the different markers for predicting lesions in capsule studies.Results: One hundred and twenty-four patients were included (85 women and 39 men). The average age was 38.21 years. Levels of C-reactive protein and fecal calprotectin were the markers more frequently associated with positive findings in capsule endoscopy. Calprotectin presented the best sensitivity as isolated marker. The association of altered levels of C-reactive protein and calprotectin showed the best specificity and predictive values.Conclusions: C-reactive protein and fecal calprotectin are appropriate biomarkers for selecting patients with suspected Crohn's disease of the small bowel for capsule endoscopy studies.

Faecal biomarkers for screening small bowel inflammation in patients with Crohn’s disease: a prospective study

“… 10 – 16 At entry, total colonoscopy was undertaken in all patients to detect large bowel inflammation. In the previous studies, 24 – 32 the methods of investigating large bowel inflammation and the timing of investigation were not recorded in detail. It is therefore unclear whether there was no large bowel inflammation at the time of collecting a stool sample.…”

“… 24 – 27 , 30 – 33 To our knowledge, this is the first study to assess the value of the three major faecal biomarkers simultaneously using the same stool sample. Further, previous studies 24 – 29 , 31 included patients with suspected (unestablished) CD. In contrast, we included only patients with established CD confined to the small bowel.…”

“…Capsule endoscopy has been commonly used in several studies. 24 – 31 Magnetic resonance enterography (MRE) 32 and balloon-assisted enteroscopy 33 are alternative techniques. We used CTE as a cross-sectional imaging technique for the assessment of small bowel inflammation because it is the most common and widely available diagnostic technology in our institute.…”

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

“…FC would be an ideal test to identify the presence of inflammatory activity in asymptomatic patients, enabling us to monitor the evolution of this activity and response to treatment. There is a high correlation between FC levels and the lesions in the small intestine observed by magnetic resonance enterography in patients with CD (37) or capsule endoscopy in patients suspected of EC and not yet diagnosed (38).…”

Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn’s disease activity?

“…Fecal calprotectin is another biomarker that has shown a good accuracy in the detection of endoscopic active disease (30,31). Although it has demonstrated a good correlation with the inflammation of the colon, its value for the assessment of small bowel inflammation in IBD remains to be elucidated.…”