Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3681
Peer-review started: May 5, 2018
First decision: May 17, 2018
Revised: June 5, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: September 7, 2018
Fecal calprotectin (FC) has emerged as one of the most useful tools for clinical management of inflammatory bowel diseases (IBD). Many different methods of assessment have been developed and different cut-offs have been suggested for different clinical settings. We carried out a comprehensive literature review of the most relevant FC-related topics: the role of FC in discriminating between IBD and irritable bowel syndrome (IBS) and its use in managing IBD patients In patients with intestinal symptoms, due to the high negative predictive value a normal FC level reliably rules out active IBD. In IBD patients a correlation with both mucosal healing and histology was found, and there is increasing evidence that FC assessment can be helpful in monitoring disease activity and response to therapy as well as in predicting relapse, post-operative recurrence or pouchitis. Recently, its use in the context of a treat-to-target approach led to a better outcome than clinically-based therapy adjustment in patients with early Crohn’s disease. In conclusion, FC measurement represents a cheap, safe and reliable test, easy to perform and with a good reproducibility. The main concerns are still related to the choice of the optimal cut-off, both for differentiating IBD from IBS, and for the management of IBD patients.
Core tip: This manuscript is a review of current literature on clinical use of fecal calprotectin in distinguishing irritable bowel syndrome from inflammatory bowel diseases and in the long-term management of inflammatory bowel disease patients, which includes monitoring of disease activity, response to therapy, disease relapse and post-operative recurrence. Concerns about the optimal cut-off in different settings have also been discussed.