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Observational Study
. 2024 Nov 25;24(1):426.
doi: 10.1186/s12876-024-03522-2.

Effect of past extensive ulcers on fecal calprotectin in ulcerative colitis

Natsuki Ishida  1 , Takatoshi Egami  2 , Tomohiro Takebe  2 , Kenichi Takahashi  2 , Yusuke Asai  2 , Satoshi Tamura  2 , Tomoharu Matsuura  3 , Mihoko Yamade  2 , Moriya Iwaizumi  3 , Yasushi Hamaya  2 , Takanori Yamada  4 , Satoshi Osawa  4 , Ken Sugimoto  2
Affiliations
Observational Study

Effect of past extensive ulcers on fecal calprotectin in ulcerative colitis

Natsuki Ishida et al. BMC Gastroenterol. .

Abstract

Background: Ulcerative colitis (UC) causes extensive ulceration attributable to intestinal inflammation. This study investigated the effect of past extensive ulcers (PEUs) on fecal calprotectin (FC).

Methods: This retrospective, single-center, observational study included patients with UC with a Mayo endoscopic subscore of 0. UC with scarring or pseudopolyposis was defined as PEU and FC and fecal immunochemical occult blood test (FIT) values were compared. The marker levels of patients in the PEU and non-PEU groups were examined to assess clinical relapse within 12 months.

Results: Of the 61 included patients, 27 had UC with PEUs and 34 had UC without PEUs. Albumin, hemoglobin, and FIT values between groups were not significantly different; however, the C-reactive protein and FC values of the PEU group were significantly higher than those of the non-PEU group. The FC values of the clinical relapse and remission groups within 12 months differed significantly. The cutoff values for the prediction of relapse within 12 months for all patients (area under the curve [AUC], 0.709; 95% confidence interval [CI], 0.512-0.907) and the non-PEU group (AUC, 0.893; 95% CI, 0.724-1.000) were both 118 mg/kg.

Conclusions: UC patients with PEUs have higher FC values than those without PEUs, even in remission. Additionally, FC values do not predict relapse in PEU patients. Therefore, FC may not be a sufficiently accurate biomarker for patients with PEUs.

Keywords: Fecal calprotectin; Fecal immunochemical occult blood test; Pseudopolyposis; Ulcerative colitis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was reviewed and approved by the Ethics Committee of Hamamatsu University School of Medicine (number 23–327). This study was conducted in accordance with the principles of Good Clinical Practice outlined in the Declaration of Helsinki. Informed consent was obtained in the form of an opt-out on the hospital website. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart PEU, past extensive ulcer
Fig. 2
Fig. 2
Endoscopic findings of colonic past extensive ulcers (PEUs). Scarring (a) and hemispherical (b), pedunculated (mucosal tag) (c), and mucosal bridge (d) morphologies are observed
Fig. 3
Fig. 3
Differences in each marker of the non-past extensive ulcer (PEU) and PEU groups. Comparisons of albumin (Alb) (a), hemoglobin (Hb) (b), C-reactive protein (CRP) (c), fecal immunochemical test (FIT) (d), and fecal calprotectin (FC) (e) values
Fig. 4
Fig. 4
Receiver-operating characteristic (ROC) curve analysis of fecal calprotectin (FC) for predicting relapse within 12 months and Kaplan–Meier analysis of the relapse-free rate. ROC analysis of all enrolled patients (a). Kaplan–Meier analysis of the relapse-free rates of all enrolled patients separated into one group with FC < 118 mg/kg and another group with FC ≥ 118 mg/kg (b). ROC analysis of the non-PEU group (c). Kaplan–Meier analysis of the relapse-free rates of patients in the non-PEU group with FC < 118 mg/kg and those in the non-PEU group with FC ≥ 118 mg/kg (d)
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