Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 May 1;21(1):197.
doi: 10.1186/s12876-021-01788-4.

Extent of disease affects the usefulness of fecal biomarkers in ulcerative colitis

Akihito Sakuraba  1 , Nobuki Nemoto  1 , Noritaka Hibi  1 , Ryo Ozaki  1 , Sotaro Tokunaga  1 , Oki Kikuchi  1 , Shintaro Minowa  1 , Tatsuya Mitsui  1 , Miki Miura  1 , Daisuke Saito  1 , Mari Hayashida  1 , Jun Miyoshi  1 , Minoru Matsuura  1 , Masayoshi Yoneyama  2 , Hiroaki Ohnishi  3 , Tadakazu Hisamatsu  4
Affiliations
Observational Study

Extent of disease affects the usefulness of fecal biomarkers in ulcerative colitis

Akihito Sakuraba et al. BMC Gastroenterol. .

Abstract

Background: Fecal biomarkers are considered to be useful surrogate markers for endoscopic activity. Given the mechanisms of fecal biomarkers, we hypothesized that the extent of ulcerative colitis (UC; pancolitis, left-sided colitis, and proctitis) could affect the usefulness of fecal biomarkers for assessing endoscopic and clinical disease activity; however, few studies have evaluated the utility of fecal biomarkers in the disease extent of UC.

Methods: Fecal calprotectin, a fecal immunochemical test for hemoglobin, and fecal lactoferrin were used as fecal biomarkers. UC patients, who underwent colonoscopy within 30 days of the fecal biomarker test, participated in this observational study. Clinical and endoscopic disease activity was assessed using the Lichtiger Index and Mayo endoscopic subscore (MES), respectively.

Results: A total of 162 colonoscopies were performed on 133 UC patients. A correlation analysis between each biomarker and the MES for each disease-extent subgroup showed a decreased correlation in the proctitis compared with the other groups. With the exception of proctitis, it was possible to distinguish between MES 0 and MES ≥ 1 with high area-under-the-curve values for fecal calprotectin and fecal lactoferrin. The fecal immunochemical test for hemoglobin was superior at discriminating MES 0 for proctitis.

Conclusions: For the practical application of fecal biomarkers for UC patients, it is necessary to consider disease extent before use. In particular, patients with proctitis exhibit a low correlation between stool biomarkers and endoscopic findings. The usefulness of these biomarkers for endoscopic remission is reduced, except for the fecal immunochemical test for hemoglobin.

Keywords: Disease extension; Fecal calprotectin; Fecal immunochemical test; Mayo endoscopic subscore; Ulcerative colitis.

PubMed Disclaimer

Conflict of interest statement

Tadakazu Hisamatsu (TH) has received grants from Alfresa Pharma Corporation related to the submitted work. TH has received consulting and lecture fees from EA Pharma Co., Ltd.; AbbVie GK.; Celgene K.K.; Janssen Pharmaceutical K.K.; Pfizer Inc.; Takeda Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Corporation; Kyorin Pharmaceutical Co., Ltd.; JIMRO Co., Ltd.; Mochida Pharmaceutical Co., Ltd.; and Nichi-Iko Pharmaceutical Co., Ltd. outside of the submitted work. TH has also received commercial research funding from EA Pharma Co., Ltd.; AbbVie GK; Daiichi-Sankyo Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Pfizer Inc.; Mochida Pharmaceutical Co., Ltd.; Nippon Kayaku Co., Ltd.; Kyorin Pharmaceutical Co., Ltd.; JIMRO Co.; Mochida Pharmaceutical Co., Ltd.; Astellas Pharma Inc.; Asahi Kasei Medical Co., Ltd.; ZERIA Pharmaceutical Co., Ltd.; and Alfresa Pharma Corporation, outside of the submitted work. Minoru Matsuura (MM) has received consulting and lecture fees from AbbVie GK.; Mitsubishi Tanabe Pharma Corporation.; EA Pharma Co.; Ltd.; Kyorin Pharmaceutical Co., Ltd.; Mochida Pharmaceutical Co., Ltd.; Janssen Pharmaceutical K.K.; Nippon Kayaku Co., Ltd.; and Kissei Pharmaceutical Co., Ltd. outside of the submitted work. MM has also received commercial research funding from AbbVie GK; Mitsubishi Tanabe Pharma Corporation; EA Pharma Co., Ltd.; Mochida Pharmaceutical Co., Ltd.; Nippon Kayaku Co., Ltd.; and JIMRO Co. outside of the submitted work. Hiroaki Ohnishi (HO) has received grants from Alfresa Pharma Corporation related to the submitted work. HO has also received commercial research funding from Ajinomoto Pharmaceutical Co., Ltd. outside of the submitted work. Akihito Sakuraba, Nobuki Nemoto, Noritaka Hibi, Ryo Ozaki, Sotaro Tokunaga, Oki Kikuchi, Shintaro Minowa, Tatsuya Mitsui, Miki Miura, Daisuke Saito, Mari Hayashida, Jun Miyoshi, and Masayoshi Yoneyama have no conflicts of interest.

Figures

Fig. 1
Fig. 1
ROC curves for fecal biomarkers (FC, FIT, or FL); MES 0, 1 vs. MES 2, 3. a All cases, b pancolitis, c Left-sided colitis, d proctitis. The AUC was lower in the proctitis group for all fecal biomarkers compared with the other subgroups. ROC receiver operating characteristic, FC fecal calprotectin, FIT fecal immunochemical test for hemoglobin, FL fecal lactoferrin, MES mayo endoscopic score, AUC area under the curve
Fig. 2
Fig. 2
ROC curves for fecal biomarkers (FC, FIT, or FL); MES 0 vs. MES 1, 2, 3. a All cases, b pancolitis, c left-sided colitis, d proctitis. All groups, except FC and FL in the proctitis group, were able to distinguish MES 0 with a high AUC. ROC Receiver operating characteristic, FC fecal calprotectin, FIT fecal immunochemical test for hemoglobin, FL fecal lactoferrin, MES mayo endoscopic score, AUC area under the curve
See this image and copyright information in PMC

References

    1. Lichtenstein GR, Rutgeerts P. Importance of mucosal healing in ulcerative colitis. Inflamm Bowel Dis. 2010;16:338–346. - PubMed
    1. Rutgeerts P, Vermeire S, Van Assche G. Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target? Gut. 2007;56:453–455. - PMC - PubMed
    1. Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141:1194–1201. - PubMed
    1. Ardizzone S, Cassinotti A, Duca P, et al. Mucosal Healing Predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis. Clin Gastroenterol Hepatol. 2011;9:483–489. - PubMed
    1. Shah SC, Colombel JF, Sands BE, Narula N. Mucosal healing is associated with improved long-term outcomes of patients with ulcerative colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14:1245–1255. - PubMed

Publication types