Published online Dec 31, 2019. doi: 10.4291/wjgp.v10.i5.54
Peer-review started: October 29, 2019
First decision: November 22, 2019
Revised: December 12, 2019
Accepted: December 23, 2019
Article in press: December 23, 2019
Published online: December 31, 2019
Studies have demonstrated a potential role for fecal biomarkers such as fecal calprotectin (FC) and fecal lactoferrin (FL) in monitoring inflammatory bowel diseases (IBD) – both Crohn’s disease (CD) and ulcerative colitis (UC). However, their correlation to endoscopic scores, disease severity and affected intestinal surface has not been extensively investigated.
Achieving a better understanding of the role of fecal markers for the evaluation and mana-gement of IBD patients.
To correlate FL, and for comparison white blood cell (WBC) and C-reactive protein (CRP), with endoscopic scores, disease extent and location in CD and UC.
Retrospective analysis in 188 patients who had FL, WBC and CRP determined within 30 d of endoscopy. Disease location, disease extent (number of intestinal segments involved), disease severity [determined by endoscopic scores: Simple Endoscopic Score for CD (SES-CD) and the endoscopic component of the Mayo Clinical score/Disease Activity Index (DAI)], timing of FL testing in relation to colonoscopy, as well as the use of effective fast acting medications (steroids and biologics) between colonoscopy and FL measurement, were recorded.
In 131 CD and 57 UC patients, both CRP and FL - but not WBC - distinguished disease severity (inactive, mild, moderate, severe). In patients receiving fast-acting treatment (steroids or biologics) in between FL measurement and colonoscopy, FL showed a higher correlation to endoscopic scores when tested before vs after the procedure (r = 0.596, P < 0.001 vs r = 0.285, P = 0.15, for SES-CD; and r = 0.402, P = 0.01, vs r = 0.054, P = 0.84 for DAI). Finally, FL was significantly correlated with the diseased mucosal surface (colon-ileocolon > small bowel) and the number of inflamed colon segments. FL and CRP separated disease severity categories. FL showed a close correlation with the involved mucosal surface and with disease extent and was more closely correlated to endoscopy when determined before the procedure – this indicating that inflammatory activity changes associated with therapy might be rapidly reflected by FL levels.
The results show a positive, significant correlation of FL and CRP with SES-CD and DAI. FL showed a close correlation with the diseased mucosal surface and with disease extent and was more closely correlated to endoscopy when determined before endoscopy. FL can accurately and timely represent intestinal inflammation in IBD.
Further validation of our findings in large scale and prospective studies might confirm that fecal markers of inflammation are accurate and inexpensive indicators of disease activity in IBD, can be used in a number of clinical scenarios and should become part of the standard armamentarium of the practicing gastroenterologist.