Fecal Calprotectin in Assessment of Ulcerative Colitis Activity

Background: It is important to evaluate the activity of inflammatory bowel disease (IBD) for the treatment. Fecal Calprotectin has been shown to be excellent marker of intestinal inflammation because it is simple, rapid, sensitive, specific, inexpensive and noninvasive to detect and monitor intestinal inflammation.

Aim: The aim of this prospective study was to evaluate the role of fecal calprotectin in diagnosis and assessment of activity of ulcerative colitis.

Methods: Prospective cross sectional study was conducted to involve thirty patients with UC and five as control. The included patients attended the gastrointestinal endoscopy clinic of the departments of internal medicine in AL-Quwayiyah General Hospital, Riadh, KSA. The study was carried out for six months from August – 2015 to January – 2016. All patients underwent lower GI fiberoptic endoscopy (proctosigmoidoscopy, ES450WE5- Fujinon and colonoscopy, EC 530 WL-Fujinon) with multiple biopsies from each patient and sent to histopathology laboratory. The patients’ disease activities were assessed according to Montreal classification and Mayo subscore. Calprotectin was measured by enzyme linked immuno-sorbentassay (ELISA) method (Calprotectin ELISA Kit, Immundiagnostik AG, Bensheim, Germany). CRP and ESR were measured in the clinical laboratory, AL-Quwayiyah General Hospital, Riadh, KSA, based on the instructions provided by the reagent manufacturer.

Results: Of the patients 25 presented by active UC ranging from mild to severe picture and 5 patients were in remission. According to endoscopic Mayo score: 5(16.67) showed Mayo score 0(remittent patients); 8(26.67%) showed Mayo score 1; 13(43.33%) showed Mayo score 2; 4(13.33%) showed Mayo score 3. The extent of UC according to Montreal classification was total (extensive) colitis 6(24%); left-sided colitis, 12(48%); and proctitis, 7(28%). There was a high significant difference in the fecal calprotectin concentration between the patients with active UC and the patients with inactive UC (P < 0.001). The FC concentration was significantly greater in the patients with inactive UC than in the controls (P < 0.001). As regard CRP and ESR; the patients with active UC had higher levels of CRP and ESR than the patients with inactive UC and the controls (P < 0.001), but there was no significant difference between the patients with inactive UC and the controls Calprotectin had a good correlation with the disease activity that the concentration was greater in severe cases than in moderate and mild cases and this difference was highly statistically significant (P<0.001).

Also CRP concentration in severe cases was greater than in moderate and mild cases and in comparison the difference was statistically significant (P<0.002). ESR concentration was higher in severe cases than moderate and mild cases but there was only statistical significant difference as regard severe and mild cases not between moderate and mild cases.

Conclusion: Fecal calprotectin is a biomarker that could differentiate active from inactive UC and our results suggest that FC can be used as a valuable, simple, noninvasive diagnostic tool for UC compared with other markers such as CRP and ESR. Keywords: ulcerative colitis, fecal calprotectin and enzyme linked immunosorbentassay (ELISA).