A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy

Abstract

Background: Capsule endoscopy (CE) is often used to investigate small bowel Crohn's disease (CD).

Aim: The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings.

Patients and methods: Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD.

Results: Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p = .048). Median calprotectin and lactoferrin in the CD group and in the control group were 169 mg/kg vs. 40 (p = .004) and 6.6 mg/kg vs. 1 (p = .051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95 mg/kg and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD.

Conclusions: Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE.

ClinicalTrials.gov Identifier: NCT01266629

Keywords:

• Capsule endoscopy
• Crohn's disease
• inflammatory bowel diseases

Acknowledgements

The authors would like to thank Faye Schreiber for editorial assistance and Nava Jelin for assistance with the statistical analysis.

Dr. Benjamin Koslowsky is providing this manuscript as the guarantor. Drs. Bar-Gil Shitrit (1), Koslowsky (2) and Adler (7) have designed the research, collected the data and performed the analysis. Drs. Livovsky (3) and Shitrit (4) have added major statistical and writing contributions. Drs. Paz (5) and Adar (6) have helped recruit the participants and collect and analyze the final data. Dr. Goldin (8) was the primary supervisor of this manuscript. All authors have approved the final version of the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

The authors received no external funding for the study.