Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 13 , ISSUE 2 ( July-December, 2023 ) > List of Articles

Original Article

Comparison of Fecal Calprotectin with Different Endoscopic Scores in the Assessment of Ulcerative Colitis (UC) Activity and Its Utility in Differentiating IBS from IBD

Kalpana Acharya, Vaishali Bhardwaj, Imran Chuahan, Syed Mushfiq, Sunil Bhatt, Brij Mohan Lamba

Keywords : Disease activity, Fecal calprotectin, Irritable bowel disease, Irritable bowel syndrome

Citation Information : Acharya K, Bhardwaj V, Chuahan I, Mushfiq S, Bhatt S, Lamba BM. Comparison of Fecal Calprotectin with Different Endoscopic Scores in the Assessment of Ulcerative Colitis (UC) Activity and Its Utility in Differentiating IBS from IBD. Euroasian J Hepatogastroenterol 2023; 13 (2):120-123.

DOI: 10.5005/jp-journals-10018-1411

License: CC BY-NC 4.0

Published Online: 26-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Ulcerative colitis (UC), a chronic inflammatory disease of gastrointestinal tract, can have initial presentation which is clinically difficult to differentiate from functional bowel disorders [irritable bowel syndrome (IBS) and irritable bowel disease (IBD)]. Conventional laboratory tests, such as erythrocyte sedimentation rate (ESR), C-reactive protein, and albumin express systemic patient responses instead of intestinal inflammation. In the last decade, fecal calprotectin, a calcium-binding protein, has been suggested as a sensitive marker of intestinal inflammation. However, only few studies have investigated its role in relation with the extent of the disease. Aim: To evaluate the usefulness of fecal calprotectin as a biomarker for disease activity in UC, its correlation with disease extent and its utility in differentiating IBS from IBD. Methods: A total of 75 patients (50 cases with colonoscopic evidence of inflammation and 25 cases with normal colonoscopic examination) were included in the study. Fecal calprotectin test was done on the day of colonoscopy. Severity of the disease was assessed by modified Mayo's endoscopy score (MMES). Results: Age and baseline parameters were comparable in both the groups (UC and IBS). Patients in the ulcerative group had tachycardia (95 vs 74), high ESR (26 vs 20), high leukocytes count (9198 vs 8852), high fecal calprotectin (594 vs 29), low albumin (3.00 vs 3.80) and low hemoglobin (11 vs 13.40). Minimum and maximum MMES were 2 and 13.2. A significant correlation was observed between fecal calprotectin and MMES (p-value < 0.001). Conclusion: Fecal calprotectin is a simple, noninvasive, cost-effective marker that is strongly associated with colorectal inflammation; moreover, it has better role in the differentiation of IBD (UC) from IBS.

  1. Magro F, Rodrigues A, Vieira AI, et al. Review of the disease course among adult ulcerative colitis population-based longitudinal cohorts. Inflamm Bowel Dis 2012;18:573–583. DOI: 10.1002/ibd. 21815.
  2. Etchevers MJ, Aceituno M, García-Bosch O, et al. Risk factors and characteristics of extent progression in ulcerative colitis. Inflamm Bowel Dis 2009;15:1320–1325. DOI: 10.1002/ibd.20897.
  3. Pepys MB, Druguet M, Klass HJ, et al. Immunological studies in inflammatory bowel disease. Ciba Found Symp 1977;46:283–304. DOI: 10.1002/9780470720288.ch14.
  4. Saverymuttu SH, Hodgson HJ, Chadwick VS, et al. Differing acute phase responses in Crohn's disease and ulcerative colitis. Gut 1986;27:809–813. DOI: 10.1136/gut.27.7.809.
  5. Mazlam MZ, Hodgson HJ. Why measure C reactive protein? Gut 1994;35:5–7. DOI: 10.1136/gut.35.1.5.
  6. Vermeire S, Van Assche G, Rutgeerts P. C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis 2004;10:661–665. DOI: 10.1097/00054725-200409000-00026.
  7. Dignass A, Eliakim R, Magro F, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis 2012;6:965–990. DOI: 10.1016/j.crohns.2012.09.003.
  8. Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007;369:1641–1657. DOI: 10.1016/S0140-6736(07)60751-X.
  9. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19(suppl A):5A–36A. DOI: 10.1155/2005/269076.
  10. Lacy BE, Patel NK. Patel Rome Criteria and a Diagnostic Approach to irritable bowel syndrome. J Clin Med 2017;6(11):99. DOI: 10.3390/jcm6110099.
  11. Lobatón T, Bessissow T, De Hertogh G, et al. The modified Mayo endoscopic score (MMES): a new index for the assessment of extension and severity of endoscopic activity in ulcerative colitis patients J Crohns Colitis 2015;9(10):846–852. DOI: 10.1093/ecco-jcc/jjv111.
  12. Aguas M, Garrigues V, Bastida G, et al. Prevalence of irritable bowel syndrome (IBS) in first-degree relatives of patients with inflammatory bowel disease (IBD). J Crohns Colitis 2011;5(3):227–233. DOI: 10.1016/j.crohns.2011.01.008.
  13. Barbara G, Cremon C, Stanghellini V. Inflammatory bowel disease and irritable bowel syndrome: similarities and differences. Curr Opin Gastroenterol 2014;30(4):352–358. DOI: 10.1097/MOG.0000000000000070.
  14. Berrill JW, Green JT, Hood K, et al. Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub-clinical inflammation and the impact on clinical assessment of disease activity. Aliment Pharmacol Ther 2013;38(1):44–51. DOI: 10.1111/apt.12335.
  15. Mosli MH, Zou G, Garg SK, et al. C-reactive protein, fecal calprotectin, and stool lactoferrin for detection of endoscopic activity in symptomatic inflammatory bowel disease patients: a systematic review and meta-analysis. Am J Gastroenterol 2015;110(6):802–820. DOI: 10.1038/ajg.2015.120.
  16. Rokkas T, Portincasa P, Koutroubakis IE. Fecal calprotectin in assessing inflammatory bowel disease endoscopic activity: a diagnostic accuracy meta-analysis. J Gastrointestin Liver Dis 2018;27(3):299–306. DOI: 10.15403/jgld.2014.1121.273.pti.
  17. Alibrahim B, Aljasser MI, Salh B. Fecal calprotectin use in inflammatory bowel disease and beyond: A mini-review. Can J Gastroenterol Hepatol 2015;29(3):157–163. DOI: 10.1155/2015/950286.
  18. Arai M, Naganuma M, Sugimoto S, et al. The Ulcerative Colitis Endoscopic Index of Severity is Useful to Predict Medium- to Long-Term Prognosis in Ulcerative Colitis Patients with Clinical Remission. J Crohns Colitis 2016;10(11):1303–1309. DOI: 10.1093/ecco-jcc/jjw104.
  19. Khalil AF, Helmy EM, Massoud MN, et al. Does faecal calprotectin differentiate between inflammatory bowel disease colitis and non-inflammatory bowel disease colitides? Prz Gastroenterol 2021;16(3):219–223. DOI: 10.5114/pg.2020.101286.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.