Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease

Abstract

Calprotectin is an abundant neutrophil protein found in both plasma and stool that is markedly elevated in infectious and inflammatory conditions, including inflammatory bowel disease (IBD). We conducted a systematic review of the published literature regarding fecal calprotectin to evaluate its potential as a noninvasive marker of neutrophilic intestinal inflammation. Reference ranges for fecal calprotectin have been established in healthy adults and children, and elevated concentrations of fecal calprotectin have been demonstrated in numerous studies of patients with IBD. Fecal calprotectin correlates well with histological inflammation as detected by colonoscopy with biopsies and has been shown successfully to predict relapses and detect pouchitis in patients with IBD. Fecal calprotectin has been shown to consistently differentiate IBD from irritable bowel syndrome because it has excellent negative predictive value in ruling out IBD in undiagnosed, symptomatic patients. Fecal calprotectin also may be useful in determining whether clinical symptoms in patients with known IBD are caused by disease flares or noninflammatory complications/underlying irritable bowel syndrome and in providing objective evidence of response to treatment. Although more studies are needed to define fully the role of fecal calprotectin, convincing studies and growing clinical experience point to an expanded role in the diagnosis and management of IBD.

Prevalence of Irritable Bowel Syndrome-like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

“…29,30 Keohane et al 9 have reported that levels of the microinflammation marker fecal calprotectin in IBD patients are significantly higher in the presence of IBS symptoms than in the absence of such symptoms. [31][32][33] This reports provides further background for the relaionship between IBS and inflammation. In this present research, our invesigation of background factors showed that the duration of disease was significantly longer in CD patients with IBS-like symptoms.…”

Review article: associations between immune activation, intestinal permeability and the irritable bowel syndrome

“…Several studies have shown that faecal calprotectin and lactoferrin levels are reliable indicators of the gut inflammatory state. [49][50][51][52] However, most studies found no difference in the faecal levels of calprotectin and lactoferrin between IBS patients and healthy controls. 43,44,49,50,[52][53][54][55][56][57][58][59] Only one publication reported that increased levels of faecal calprotectin were correlated with pain severity; however, this result was observed in children displaying both functional abdominal pain and IBS.…”

Faecal leukocyte esterase activity is an alternative biomarker in inflammatory bowel disease

“…Other faecal neutrophil-derived proteins (e.g., lysozyme, myeloperoxidase, granulocyte elastase, S100A12) have been investigated in IBD with less success [8]. Calprotectin, lactoferrin and other proteins are produced in significant Brought to you by | University of Ghent Authenticated Download Date | 2/24/16 4:28 PM amounts by inflammatory cells and these biomarkers correlate well with colorectal and intestinal inflammation [12,13]. The faecal excretion of Indium 111-labelled leukocytes is still the golden standard faecal marker of inflammation.…”