Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2018; 24(33): 3681-3694
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3681
From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting
Maria Gloria Mumolo, Lorenzo Bertani, Linda Ceccarelli, Gabriella Laino, Giorgia Di Fluri, Eleonora Albano, Gherardo Tapete, Francesco Costa
Maria Gloria Mumolo, Linda Ceccarelli, Giorgia Di Fluri, Francesco Costa, Department of General Surgery and Gastroenterology, Gastroenterology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa 56124, Italy
Lorenzo Bertani, Gabriella Laino, Eleonora Albano, Gherardo Tapete, Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa 56122, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: The authors have declared that no potential conflict of interest exists.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Francesco Costa, MD, PhD, Chief Doctor, Gastroenterology Unit, Azienda Ospedaliero Universitaria Pisana, via Paradisa 2, Pisa 56124, Italy.
Telephone: +39-050997392 Fax: +39-050997392
Received: May 4, 2018
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.

Keywords: Fecal calprotectin, Inflammatory bowel diseases, Crohn’s disease, Ulcerative colitis, Irritable bowel syndrome

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.