Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1266
Peer-review started: December 6, 2018
First decision: January 6, 2019
Revised: January 16, 2019
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: March 14, 2019
Asymptomatic children with Crohn’s disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.
In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.
In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn’s Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.
53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 μg/g (283-1758) vs 244 μg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).
Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.
Core tip: It has becoming increasingly evident that many children with Crohn’s disease (CD) who are in clinical remission continue to have ongoing active intestinal inflammation. This prospective paediatric study demonstrates the utility of fecal calprotectin monitoring in asymptomatic children with CD. In this study, a significant number of children were found to have elevated levels despite clinical remission, and levels of > 250 μg/g were found to be a good predictor of clinical relapse in the subsequent 3 mo.