Utility of fecal calprotectin in the diagnosis of inflammatory bowel diseases
DOI:
https://doi.org/10.56294/saludcyt20251125Keywords:
Inflammatory bowel disease, Crohn's disease, ulcerative colitis, fecal calprotectin, sensitivityAbstract
Introduction: Inflammatory bowel disease involves two main disorders: Crohn's disease and ulcerative colitis. Colonoscopy with biopsy is considered the gold standard for the diagnosis of IBD, although these are invasive and costly techniques. In recent years, fecal calprotectin has gained relevance as a non-invasive biomarker with significant clinical utility. The effectiveness of fecal calprotectin has been demonstrated in distinguishing between IBD and irritable bowel syndrome, predicting endoscopic and histological activity, as well as disease recurrence.
Objective: Review the current literature on the clinical utility of fecal calprotectin in the diagnosis and management of inflammatory bowel diseases.
Methods: Systematic review based on the PRISMA method, of studies obtained through searches in Scopus, PubMed, Virtual Health Library, Web of Science, Latindex, and Google Scholar. Primary and secondary studies published in the last five years in English and Spanish were included.
Results: Nineteen studies were analyzed, describing high sensitivity and specificity in distinguishing IBD from IBS, helping to reduce the rate of unnecessary colonoscopies in patients with non-specific gastrointestinal symptoms. Additionally, fecal calprotectin was found to significantly correlate with endoscopic and histological activity.
Conclusions: Fecal calprotectin is a reliable biomarker of mucosal inflammation, capable of identifying patients with a higher likelihood of having IBD, allowing for better management of colonoscopy resources and reducing associated costs.
References
1. Jukic A, Bakiri L, Wagner EF, Tilg H, Adolph TE. Calprotectin: from biomarker to biological function. Gut [Internet]. 2021 Oct 1 [cited 2024 Sep 17];70(10):1978–88. Available from: https://doi.org/10.1136/gutjnl-2021-324855
2. Desai D, Dhoble P. Rapidly changing epidemiology of inflammatory bowel disease: Time to gear up for the challenge before it is too late [Internet]. Vol. 43, Indian Journal of Gastroenterology. Springer; 2024 [cited 2024 Sep 17]. p. 15–7. Available from: https://doi.org/10.1007/s12664-023-01453-6
3. Figueroa C. Epidemiología de la enfermedad inflamatoria intestinal. Rev Médica Clínica Las Condes [Internet]. 2019 Jul 1 [cited 2024 Oct 23];30(4):257–61. Available from: https://doi.org/10.1016/j.rmclc.2019.06.003
4. Khaki-Khatibi F, Qujeq D, Kashifard M, Moein S, Maniati M, Vaghari-Tabari M. Calprotectin in inflammatory bowel disease [Internet]. Vol. 510, Clinica Chimica Acta. Elsevier; 2020 [cited 2024 Sep 17]. p. 556–65. Available from: https://doi.org/10.1016/j.cca.2020.08.025
5. Borowitz SM. The epidemiology of inflammatory bowel disease: Clues to pathogenesis? Front Pediatr [Internet]. 2023 Jan 18 [cited 2024 Sep 17];10:1103713. Available from: https://doi.org/10.3389/fped.2022.1103713
6. Maldonado-Arriaga B, Sandoval-Jiménez S, Rodríguez-Silverio J, Alcaráz-Estrada SL, Cortés-Espinosa T, de Vaca RPC, et al. Patient knowledge of fecal calprotectin in inflammatory bowel disease (IBD): An observational study in Mexico [version 1; peer review: 1 approved with reservations]. F1000Research [Internet]. 2021 Dec 21 [cited 2024 Sep 17];9:1–15. Available from: https://doi.org/10.12688/f1000research.27629.1
7. D’Amico F, Rubin DT, Kotze PG, Magro F, Siegmund B, Kobayashi T, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. UEG J [Internet]. 2021 May 1 [cited 2024 Sep 17];9(4):451–60. Available from: https://doi.org/10.1002/ueg2.12069
8. Inciarte-Mundo J, Frade-Sosa B, Sanmartí R. From bench to bedside: Calprotectin (S100A8/S100A9) as a biomarker in rheumatoid arthritis. Front Immunol [Internet]. 2022 Nov 3 [cited 2024 Sep 17];13:1001025. Available from: https://doi.org/10.3389/fimmu.2022.1001025
9. Kapel N, Ouni H, Benahmed NA, Barbot-Trystram L. Fecal calprotectin for the diagnosis and management of inflammatory bowel diseases. Clin Transl Gastroenterol [Internet]. 2023 [cited 2024 Sep 17]; Available from: https://doi.org/10.14309/ctg.0000000000000617
10. Campbell JP, Zierold C, Rode AM, Blocki FA, Vaughn BP. Clinical Performance of a Novel LIAISON Fecal Calprotectin Assay for Differentiation of Inflammatory Bowel Disease from Irritable Bowel Syndrome. J Clin Gastroenterol [Internet]. 2021;55(3):239–43. Available from: https://doi.org/10.1097/MCG.0000000000001359
11. Berinstein JA, Steiner CA, Bousvaros A, Tiongco FP, Greenberg E, Hardi R, et al. The Clinical Accuracy of the BÜHLMANN fCAL ELISA in the Differentiation of Inflammatory Bowel Disease From Irritable Bowel Syndrome: A Multicenter Prospective Case–Control Study. Crohn’s Colitis 360 [Internet]. 2019 Oct 1 [cited 2024 Oct 12];1(3). Available from: https://dx.doi.org/10.1093/crocol/otz037
12. Chowdhury MFK, Ghosh CK, Miah MSA, Rassell M, Hasan MA, Saha C, et al. Faecal Calprotectin in Differentiating Inflammatory Bowel Disease (IBD) from Irritable Bowel Syndrome (IBS). Bangladesh Med J [Internet]. 2021 Jan 31 [cited 2024 Oct 12];50(1):15–22. Available from: https://doi.org/10.3329/bmj.v50i1.58248
13. Dajti E, Frazzoni L, Iascone V, Secco M, Vestito A, Fuccio L, et al. Systematic review with meta-analysis: Diagnostic performance of faecal calprotectin in distinguishing inflammatory bowel disease from irritable bowel syndrome in adults. Aliment Pharmacol Ther [Internet]. 2023 Dec 1 [cited 2024 Oct 12];58(11–12):1120–31. Available from: https://doi.org/10.1111/apt.17754
14. Shentova R, Baycheva M, Hadjiiski P, Kofinova D, Yaneva P. Role of faecal calprotectin as a predictor of endoscopic activity in paediatric patients with ulcerative colitis [Internet]. Vol. 43, Gastroenterologia y Hepatologia. Gastroenterol Hepatol; 2020 [cited 2024 Oct 12]. p. 57–61. Available from: https://doi.org/10.1016/j.gastrohep.2019.08.011
15. Lee YW, Lee KM, Lee JM, Chung YY, Kim DB, Kim YJ, et al. The usefulness of fecal calprotectin in assessing inflammatory bowel disease activity. Korean J Intern Med [Internet]. 2019 Jan 1 [cited 2024 Oct 12];34(1):72–80. Available from: https://doi.org/10.3904/kjim.2016.324
16. Mak LY, Tong TSM, Cheung KS, Chen LJ, Lui KL, Lau KS, et al. Combined Use of Common Fecal and Blood Markers for Detection of Endoscopically Active Inflammatory Bowel Disease. Clin Transl Gastroenterol [Internet]. 2020 Mar 1 [cited 2024 Oct 12];11(3):e00138. Available from: https://doi.org/10.14309/ctg.0000000000000138
17. Walsh A, Kormilitzin A, Hinds C, Sexton V, Brain O, Keshav S, et al. Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis-a Prospective Analysis [Internet]. Vol. 13, Journal of Crohn’s and Colitis. Oxford Academic; 2019 [cited 2024 Oct 12]. p. 424–30. Available from: https://dx.doi.org/10.1093/ecco-jcc/jjy184
18. Hart L, Chavannes M, Kherad O, Maedler C, Mourad N, Marcus V, et al. Faecal calprotectin predicts endoscopic and histological activity in clinically quiescent ulcerative colitis. J Crohn’s Colitis [Internet]. 2020 Jan 1 [cited 2024 Oct 12];14(1):46–52. Available from: https://dx.doi.org/10.1093/ecco-jcc/jjz107
19. Fiorino G, Danese S, Peyrin-Biroulet L, Sans M, Bonelli F, Calleri M, et al. LIAISON® Calprotectin for the prediction of relapse in quiescent ulcerative colitis: The EuReCa study. United Eur Gastroenterol J [Internet]. 2022 Oct 1 [cited 2024 Oct 12];10(8):836–43. Available from: https://doi.org/10.1002/ueg2.12268
20. Buisson A, Mak WY, Andersen MJ, Lei D, Kahn SA, Pekow J, et al. Faecal Calprotectin Is a Very Reliable Tool to Predict and Monitor the Risk of Relapse after Therapeutic De-escalation in Patients with Inflammatory Bowel Diseases. J Crohn’s Colitis [Internet]. 2019 Aug 14 [cited 2024 Oct 12];13(8):1012–24. Available from: https://doi.org/10.1093/ecco-jcc/jjz023
21. Monteiro S, Dias de Castro F, Leite S, Moreira MJ, Cotter J. Low fecal calprotectin predicts clinical remission in Crohn’s disease patients: the simple answer to a challenging question. Scand J Gastroenterol [Internet]. 2019 Jan 2 [cited 2024 Oct 12];54(1):49–54. Available from: https://doi.org/10.1080/00365521.2018.1549683
22. Shi JT, Chen N, Xu J, Goyal H, Wu ZQ, Zhang JX, et al. Diagnostic Accuracy of Fecal Calprotectin for Predicting Relapse in Inflammatory Bowel Disease: A Meta-Analysis [Internet]. Vol. 12, Journal of Clinical Medicine. MDPI; 2023 [cited 2024 Oct 12]. p. 12. Available from: https://doi.org/10.3390/jcm12031206
23. D’Amico F, Nancey S, Danese S, Peyrin-Biroulet L. A Practical Guide for Faecal Calprotectin Measurement: Myths and Realities. J Crohn’s Colitis [Internet]. 2021 Jan 13 [cited 2024 Oct 12];15(1):152–61. Available from: https://dx.doi.org/10.1093/ecco-jcc/jjaa093
24. Cabra R, Castaño M, Serrano A, León A, Vázquez I, Vázquez J, et al. Estudio comparativo entre diferentes métodos para la determinación de la calprotectina fecal. Rev Med Lab ISSN 2660-7484, ISSN-e 2660-7638, Vol 2, No 1, 2021, págs 3-10 [Internet]. 2021 [cited 2024 Oct 12];2(1):3–10. Available from: http://dx.doi.org/10.20960/revmedlab.00015
25. Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Fecal calprotectin in pediatric gastrointestinal diseases: Pros and cons [Internet]. Vol. 13, World Journal of Clinical Pediatrics. Baishideng Publishing Group Inc; 2024 [cited 2024 Oct 12]. Available from: https://doi.org/10.5409/wjcp.v13.i2.93341
26. D’Incà R, Sturniolo G. Biomarkers in IBD: What to Utilize for the Diagnosis? [Internet]. Vol. 13, Diagnostics. Multidisciplinary Digital Publishing Institute; 2023 [cited 2024 Oct 12]. p. 2931. Available from: https://doi.org/10.3390/diagnostics13182931
27. Alghoul Z, Yang C, Merlin D. The Current Status of Molecular Biomarkers for Inflammatory Bowel Disease [Internet]. Vol. 10, Biomedicines. Multidisciplinary Digital Publishing Institute (MDPI); 2022 [cited 2024 Oct 12]. Available from: https://doi.org/10.3390/biomedicines10071492
28. Shi JT, Zhang Y, She Y, Goyal H, Wu ZQ, Xu HG. Diagnostic Utility of Non-invasive Tests for Inflammatory Bowel Disease: An Umbrella Review [Internet]. Vol. 9, Frontiers in Medicine. Frontiers Media S.A.; 2022 [cited 2024 Oct 12]. Available from: https://doi.org/10.3389/fmed.2022.920732
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