Faecal matrix metalloprotease-9 is a more sensitive marker for diagnosing pouchitis than faecal calprotectin: results from a pilot study

Abstract

Background: Potential non-invasive markers of pouchitis would have a great deal of significance within clinical practice. Aim: This study is aimed at assessing the diagnostic accuracy of fecal calprotectin and matrix metalloprotease-9 as potential markers in patients both with and without pouchitis. Patients and methods: Stool and blood samples were collected from 33 ileal pouch-anal anastomosis patients before a follow-up pouchoscopy. Biopsy samples were taken for histological purposes. The presence of cuffitis and stenosis was evaluated with an endoscopy. Calprotectin and matrix metalloprotease-9 were quantified with an enzyme-linked immunosorbent assay. Results: Pouchitis was detected in 30.3% of the patients. The levels of fecal calprotectin and matrix metalloprotease-9 increased significantly in patients with pouchitis. The sensitivity and specificity of matrix metalloprotease-9 was higher than that of fecal calprotectin. Only matrix metalloprotease-9 correlated significantly with the severity of pouchitis. Discussion: Fecal matrix metalloprotease-9 has a high specificity in the diagnosis of pouchitis.

Keywords:

• fecal calprotectin
• ileal pouch-anal anastomosis
• matrix metalloprotease-9
• pouchitis
• ulcerative colitis

Financial & competing interest disclosure

This work was supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences (BO/00632/14/5), TAMOP-4.2.2.A-11/1/KONV-2012-0035, TAMOP-4.2.2-A-11/1/KONV-2012-0052 TAMOP-4.2.2.A-11/1/KONV-2012-0073 and OTKA PD 105948 (PI: Klaudia Farkas). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The incidence of pouchitis after total proctocolectomy with ileal pouch-anal anastomosis is high.

• The gold standard for assessing pouchitis is endoscopy.

• Only limited data are available on the diagnostic accuracy of fecal calprotectin and in pouchitis.

• Sensitivity of fecal matrix metalloprotease-9 (MMP-9) has never been examined in pouchitis.

• Our study revealed that both fecal calprotectin and fecal MMP-9 concentrations were significantly higher in patients with versus without pouchitis. However, a significant correlation was revealed only between fecal MMP-9 and the severity of pouchitis.

• Fecal MMP-9 seems to have higher specificity in the detection of pouchitis.

Notes