Fecal calprotectin for the prediction of small-bowel Crohn’s disease by capsule endoscopy: a systematic review and meta-analysis

Kopylov, Uri; Yung, Diana E; Engel, Tal; Avni, Tomer; Battat, Robert; Ben‐Horin, Shomron; Plevris, John; Eliakim, Rami; Koulaouzidis, Anastasios

doi:10.1097/meg.0000000000000692

Cited by 99 publications

(91 citation statements)

References 34 publications

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“…21, 22 Although isolated small bowel CD represents a small percentage (2.9%–13%) 23, 24 of newly diagnosed pediatric CD, unrecognized or poorly treated small bowel Crohn’s can lead to significant complications. Additional research is needed to determine the accuracy of CD64 testing in patients with isolated small bowel Crohn’s as we had a limited number (9/60) of L1 subjects.…”

Section: Discussionmentioning

confidence: 99%

Validation of Neutrophil CD64 Blood Biomarkers to Detect Mucosal Inflammation in Pediatric Crohn’s Disease

Minar

Jackson

Tsai

et al. 2017

Inflammatory Bowel Diseases

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Background In a pilot study, neutrophil CD64 surface expression was significantly elevated in newly diagnosed, pediatric-onset Crohn’s disease. We aimed to test the CD64 biomarkers (neutrophil CD64 surface expression and soluble CD64) as determinates for mucosal inflammation in a larger pediatric Crohn’s cohort with the hypotheses that the CD64 biomarkers would reliably detect intestinal inflammation and correlate with endoscopic severity scores. Methods We enrolled patients referred for colonoscopy for either suspected inflammatory bowel disease or with established Crohn’s. Neutrophil CD64 index was determined by flow cytometry using a commercial kit (Leuko64, Trillium) and soluble CD64 by ELISA (LifeSpan). Results A total of 209 patients (72 controls, 76 new inflammatory bowel disease patients, and 61 established Crohn’s) were enrolled. Both neutrophil CD64 index and soluble CD64 were significantly elevated in new Crohn’s compared with controls. The area under the curve (AUC) for neutrophil CD64 index ≥1 was 0.85 (95% confidence interval, 0.77–0.92), 75% sensitive and 89% specific for new Crohn’s. Comparatively, soluble CD64 ≥39 ng/mL was 92% sensitive and 85% specific (AUC, 0.93) for new Crohn’s. Neutrophil CD64 index, soluble CD64, and fecal calprotectin discriminated endoscopic inactive from moderate and severe activity while soluble CD64 differentiated endoscopic mild from moderate and severe activity. Neutrophil CD64 index (r = 0.46, P < 0.001) and fecal calprotectin (r = 0.55, P < 0.001) correlated well with the Simple Endoscopic Score–Crohn’s disease. Spearman correlation between the CD64 index and calprotectin was 0.39 (P < 0.001). Conclusions In a large Crohn’s disease cohort, we found that neutrophil CD64 index and soluble CD64 were significantly elevated during active gastrointestinal inflammation.

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Section: Discussionmentioning

confidence: 99%

Validation of Neutrophil CD64 Blood Biomarkers to Detect Mucosal Inflammation in Pediatric Crohn’s Disease

Minar

Jackson

Tsai

et al. 2017

Inflammatory Bowel Diseases

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“…An FC of 50 μg/g had a sensitivity of 83%, a specificity of 53%, and a DOR of −5.64. The study suggested that in patients with less than 50 μg/g, the likelihood of positive diagnosis is very low …”

Section: Resultsmentioning

confidence: 98%

“…This limit has been overcome by lowering FC cutoff, in most of the studies using CE. In this regard, a meta‐analysis by Kopylov showed that an FC concentration > 50 μg/g had 83% sensitivity, but only 53% specificity for active CD . On the other hand, the excellent NPV suggests that the likelihood of CD‐related lesions is poor when FC is < 50 μg/g and ileocolonoscopy is negative.…”

Section: Discussionmentioning

confidence: 99%

Is fecal calprotectin an accurate marker in the management of Crohn's disease?

Vernia

Ruscio

Stefanelli

et al. 2019

J of Gastro and Hepatol

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Although lacking validated cutoff values, fecal calprotectin (FC), besides C‐reactive protein, is considered the standard test for assessing disease activity in Crohn's disease (CD). The aim of the present review is to provide a general overview of the literature addressing the role of FC in the clinical and endoscopic assessment of disease activity in CD, seeking correlations with capsule endoscopy, response to therapy, prediction of relapse, and postoperative recurrence. A systematic search of the literature up to September 2019 was performed using Medline, Embase, and the Cochrane Library. Only papers written in English concerning FC in adult patients affected by CD were included. Pediatric studies, in vitro studies, animal studies, studies on blood/serum samples, and studies analyzing FC in ulcerative colitis or in both CD and ulcerative colitis were excluded. Out of 713 citations, 65 eligible studies were identified. FC showed high accuracy in the assessment of intestinal inflammation and response to therapy, in particular in colonic disease, thus proving a good surrogate marker for these aims. FC is useful in identifying patients at high risk for endoscopic relapse or postoperative recurrence, for optimizing or downstage therapy. Unfortunately, FC performs less well in small bowel CD. FC is an effective fecal marker in the management of CD patients, optimizing the use of endoscopic procedures. Owing to its diagnostic accuracy, FC may represent a cornerstone of the “treat‐to‐target” management strategy of CD patients.

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“…However, a recent meta-analysis has shown that elevated FC in patients with normal ileocolonoscopy was associated with active small bowel inflammation [45].…”

Section: Faecal Calprotectinmentioning

confidence: 99%

Luminally expressed gastrointestinal biomarkers

Cummins

Yung

Cox

et al. 2017

Expert Review of Gastroenterology & Hepatology

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Fecal calprotectin for the prediction of small-bowel Crohn’s disease by capsule endoscopy: a systematic review and meta-analysis

Abstract: Fecal calprotectin has a significant diagnostic accuracy for the detection of small-bowel CD. Our results suggest that in patients with suspected CD with calprotectin <50 μg/g, the likelihood of positive diagnosis is very low.

Cited by 99 publications

References 34 publications

Validation of Neutrophil CD64 Blood Biomarkers to Detect Mucosal Inflammation in Pediatric Crohn’s Disease

Validation of Neutrophil CD64 Blood Biomarkers to Detect Mucosal Inflammation in Pediatric Crohn’s Disease

Is fecal calprotectin an accurate marker in the management of Crohn's disease?

Luminally expressed gastrointestinal biomarkers

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