Fecal calprotectin is not a clinically useful marker for the prediction of the early nonresponse to exclusive enteral nutrition in pediatric patients with Crohn disease

Copova, Ivana; Hradský, Ondřej; Zárubová, Kristýna; Gonsorcikova, Lucie; Potuznikova, Kristyna; Lerchova, Tereza; Nevoral, Jiří; Bronský, Jiří

doi:10.1007/s00431-018-3228-5

Cited by 5 publications

(7 citation statements)

References 30 publications

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“…Similar results were obtained by Sipponen and Kolho [5]. In patients diagnosed with organic diseases, including IBD, calprotectin levels were reported to surpass 100 µg/g [19, 22]. On the basis of this test, high specificity was stated when normal levels were assumed as being <100 µg/g [22].…”

Section: Calprotectin and Ibdsupporting

confidence: 70%

“…The presence of high levels of FC was evidenced in the course of IBD [8, 20]. The first reports of this observation appeared in the 1990s; a positive correlation was observed between the calprotectin level and the intensity of inflammatory lesions in the intestines [10, 21, 22]. According to Pieczarkowski et al [23], a calprotectin level <100 µg/g concerns mainly patients with functional gastrointestinal disorder and children from the control group.…”

Section: Calprotectin and Ibdmentioning

confidence: 99%

“…In patients diagnosed with organic diseases, including IBD, calprotectin levels were reported to surpass 100 µg/g [19, 22]. On the basis of this test, high specificity was stated when normal levels were assumed as being <100 µg/g [22]. A meta-analysis suggested that assuming a calprotectin cutoff as 212 µg/g should increase the accuracy of referral for endoscopy [24].…”

Section: Calprotectin and Ibdmentioning

confidence: 99%

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Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice

et al. 2020

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Gastrointestinal tract symptoms such as abdominal pain, constipation, diarrhea, and fever are frequent causes of visits to the pediatrician. The increasing prevalence of chronic gastrointestinal tract diseases, and the falling median age of their onset, indicate the need to identify new diagnostic methods that can differentiate inflammatory bowel diseases from other gastrointestinal tract conditions. A promising non-invasive and useful marker of intestinal inflammation is fecal calprotectin. The manuscript summarizes currently available information on the use of fecal calprotectin in the diagnosis and monitoring of inflammatory bowel disease in children. It also attempts to determine the effect of concentration on its course of action. Incorporating fecal calprotectin (FC) testing within the framework of primary medical care can decrease the number of children unnecessarily referred for endoscopic or radiologic examination. FC screening benefits patients by reducing any delay in diagnosis and avoiding unnecessary exposure to endoscopy, and benefits physicians by reducing pressure on endoscopy testing and assisting the decision. The present paper emphasizes the role of fecal calprotectin as a non-invasive marker for monitoring disease activity and efficacy of therapy, and predicting postoperative relapses, primarily in patients with IBD.

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Section: Calprotectin and Ibdsupporting

confidence: 70%

Section: Calprotectin and Ibdmentioning

confidence: 99%

Section: Calprotectin and Ibdmentioning

confidence: 99%

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Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice

et al. 2020

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“…Nevertheless, from adult studies, if no findings in endoscopy are reported, the frequency of detecting lesions when performing capsule endoscopy correlates with increasing FC values (FC < 50 mg/g, 10%; FC 50-100 mg/g, 25%; FC >100 mg/g, 62%) (116). With a rapid-onset therapeutic agent, such as Infliximab, the FC levels may drop back into the normal range within 2 weeks (89,117), although with exclusive enteral nutrition (EEN), the decline may be less clear and occur over a longer period of 6 to 8 weeks of therapy (79,(118)(119)(120)(121). The reduction of FC values during EEN; however, is lost rapidly after food re-introduction (118,122).…”

Section: Recommendationmentioning

confidence: 99%

The Use of Fecal Calprotectin Testing in Paediatric Disorders

Köninckx

Aliaga

Benninga

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.

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“…However, there are conflicting reports on the prediction of the clinical response to changes in FC early after treatment. An early decrease in FC levels in children with luminal CD did not predict clinical response after six weeks of EEN induction therapy, and CR was predicted with low accuracy [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Fecal Calprotectin Assay at an Early Stage of Treatment Can Be Used as a Surrogate Marker to Predict Clinical Remission and Mucosal Healing in Pediatric Crohn’s Disease

Lee

Park

2022

Pediatr Gastroenterol Hepatol Nutr

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Purpose This study evaluated the predictive role of fecal calprotectin (FC) measured at an early stage of treatment for monitoring clinical remission (CR) after six months and endoscopic remission (ER) after one year of treatment in pediatric Crohn’s disease (CD). Methods This retrospective study included 45 patients who simultaneously underwent ileocolonoscopy and FC testing during follow-up. FC levels were measured before and after six weeks of treatment. CR was assessed after six months of treatment using Pediatric Crohn’ s Disease Activity Index and acute-phase reactants. ER was assessed after one year using the Simple Endoscopic Score for Crohn’s Disease. Results Twenty-nine (64.4%) patients used oral prednisolone for remission induction and 16 (35.6%) patients used anti-tumor necrosis factor-alpha. Thirty (66.7%) patients achieved CR, while 24 (53.3%) achieved ER. The FC level measured after six weeks of treatment could predict CR (χ 2 =9.15, p =0.0025) and ER (χ 2 =12.31, p =0.0004). The δFC could predict CR (χ 2 =7.91, p =0.0049), but not ER (χ 2 =1.85, p =0.1738). With a threshold of ≤950.4 µg/g, FC at week six could predict CR with 76.7% sensitivity and 73.3% specificity. The area under the curve (AUC) was 0.769 (standard error 0.0773, p =0.0005). The same threshold predicted ER with 87.5% sensitivity and 71.4% specificity. The AUC was 0.774 (standard error 0.074, p =0.0002). Conclusion FC assay at an early stage of treatment can be used as a surrogate marker to predict CR and mucosal healing in pediatric CD.

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Fecal calprotectin is not a clinically useful marker for the prediction of the early nonresponse to exclusive enteral nutrition in pediatric patients with Crohn disease

Cited by 5 publications

References 30 publications

Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice

Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice

The Use of Fecal Calprotectin Testing in Paediatric Disorders

Fecal Calprotectin Assay at an Early Stage of Treatment Can Be Used as a Surrogate Marker to Predict Clinical Remission and Mucosal Healing in Pediatric Crohn’s Disease

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