Faecal calprotectin: Management in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is a chronic and relapsing disorder which leads to an inflammation of the gastrointestinal tract. A tailored therapy to achieve mucosal healing with the less adverse events has become a key issue in the management of IBD. In the past, the clinical remission was the most important factor to consider for adapting diagnostic procedures and therapeutic strategies. However, there is no a good correlation between symptoms and intestinal lesions, so currently the goals of treatment are to achieve not only the control of symptoms, but deep remission, which is related with a favourable prognosis. Thus, the determination of biological markers or biomarkers of intestinal inflammation play a crucial role. Many biomarkers have been extensively evaluated in IBD showing significant correlation with endoscopic lesions, risk of recurrence and response to treatment. One of the most important markers is faecal calprotectin (FC). Despite calprotectin limitations, this biomarker represents a reliable and noninvasive alternative to reduce the need for endoscopic procedures. FC has demonstrated its performance for regular monitoring of IBD patients, not only to the diagnosis for discriminating IBD from non-IBD diagnosis, but for assessing disease activity, relapse prediction and response to therapy. Although, FC provides better results than other biomarkers such as C-reactive protein and erythrocyte sedimentation rate, these surrogate markers of intestinal inflammation should not be used isolation but in combination with other clinical, endoscopic, radiological or/and histological parameters enabling a comprehensive assessment of IBD patients.

Keywords: Faecal calprotectin, Inflammatory bowel disease, Biomarkers, Ulcerative colitis, Crohn’s disease, Relapse

Core tip: The surveillance of inflammatory bowel disease (IBD) course is needed to select the patients with worse prognosis and to adapt an early therapeutic strategy. Faecal calprotectin constitutes a surrogate marker of intestinal inflammation and a robust alternative to invasive procedures as endoscopy. This biomarker has been demonstrated reliable and accuracy in different aspects of IBD such as diagnosis of IBD, activity assessment, response to treatment and relapse prediction. Although a cut-off level of calprotectin has not been fully established, the combination with other biomarkers allows an appropriate management of the patient.