Fecal calprotectin and endoscopic scores: The cornerstones in clinical practice for evaluating mucosal healing in inflammatory bowel disease

Table 2 Advantages and limitations of fecal calprotectin and endoscopy in patients with inflammatory bowel disease

	Fecal calprotectin	Endoscopy
Advantages	Noninvasive	Direct evaluation of the mucosa
	Low-cost, cost-effective	Gold standard method to evaluate the goal of IBD treatment (mucosal healing)
	Easy collection and storage	Possibility of obtaining samples (biopsies)
	Validated in UC and CD	Validated in IBD diagnostic, monitoring, and prediction of disease activity
	Validated in both colonic and small bowel disease	Validated in adults and pediatric population
	Validated in IBD diagnostic, monitoring, and prediction of disease activity	Validated scores for both UC and CD
	Validated in adults and pediatric population
	Distinguish patients with IBD from those with IBS
Limitations	Not specific for IBD	Invasive
	Not differentiated UC from CD	Cost
	No validated cutoff to define disease activity	Availability
	Presence of a “gray zone” level between 100 and 250 μg/g, which is difficult to interpret	Inter-observer variability
	Lower accuracy in detecting inflammatory activity in patients with CD of the small intestine or of the upper gastrointestinal tract compared to predominant or extensive colonic involvement
	Variation depending on patient age, presence of obesity, and lifestyle
	The presence of mucus and blood can interfere with FC result
	High day-to-day variability
	Despite the low cost, it is not available in some locations

CD: Crohn’s disease; IBD: Inflammatory bowel disease; IBS: Irritable bowel syndrome; UC: Ulcerative colitis.