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World J Gastroenterol. Sep 28, 2008; 14(36): 5584-5589
Published online Sep 28, 2008. doi: 10.3748/wjg.14.5584
Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease
Michael Wagner, Christer GB Peterson, Peter Ridefelt, Per Sangfelt, Marie Carlson
Michael Wagner, Per Sangfelt, Marie Carlson, Department of Medical Sciences, Gastroenterology Research Group, University Hospital, SE-751 85 Uppsala, Sweden
Christer GB Peterson, Peter Ridefelt, Department of Medical Sciences, Clinical Chemistry, University Hospital, SE-751 85 Uppsala, Sweden
Author contributions: Sangfelt P and Carlson M contributed equally to this work; Sangfelt P, Peterson ChGB and Carlson M designed research; Wagner M, Sangfelt P, Peterson ChGB and Carlson M performed research; Ridefelt P contributed analytic tools; Wagner M, Sangfelt P, Peterson ChGB and Carlson M analyzed data; Wagner M, Sangfelt P, and Carlson M wrote the paper.
Supported by Grants from the Medical Faculty, Uppsala University, Uppsala, Sweden
Correspondence to: Marie Carlson, MD, PhD, Associate Professor, Department of Medical Sciences, Gastroenterology Research Group, University Hospital, SE-751 85 Uppsala, Sweden. marie.carlson@akademiska.se
Telephone: + 46-18-6114249 Fax: + 46-18-6113703
Received: June 13, 2008
Revised: August 14, 2008
Accepted: August 21, 2008
Published online: September 28, 2008
Abstract

AIM: To evaluate fecal calprotectin (FC) as a surrogate marker of treatment outcome of relapse of inflammatory bowel disease (IBD) and, to compare FC with fecal myeloperoxidase (MPO) and fecal eosinophil protein X (EPX).

METHODS: Thirty eight patients with IBD, comprising of 27 with ulcerative colitis (UC) and 11 with Crohn’s disease (CD) were investigated before treatment (inclusion), and after 4 and 8 wk of treatment. Treatment outcomes were evaluated by clinical features of disease activity and endoscopy in UC patients, and disease activity in CD patients. In addition, fecal samples were analyzed for FC by enzyme-linked immunosorbent assay (ELISA), and for MPO and EPX with radioimmunoassay (RIA).

RESULTS: At inclusion 37 of 38 (97%) patients had elevated FC levels (> 94.7 μg/g). At the end of the study, 31 of 38 (82%) patients fulfilled predefined criteria of a complete response [UC 21/27 (78%); CD 10/11 (91%)]. Overall, a normalized FC level at the end of the study predicted a complete response in 100% patients, whereas elevated FC level predicted incomplete response in 30%. Normalized MPO or EPX levels predicted a complete response in 100% and 90% of the patients, respectively. However, elevated MPO or EPX levels predicted incomplete response in 23% and 22%, respectively.

CONCLUSION: A normalized FC level has the potential to be used as a surrogate marker for successful treatment outcome in IBD patients. However, patients with persistent elevation of FC levels need further evaluation. FC and MPO provide superior discrimination than EPX in IBD treatment outcome.

Keywords: Fecal markers, Calprotectin, Myelope-roxidase, Eosinophil protein X treatment, Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease