Faecal Calprotectin and 7-α Cholestenone Levels in Microscopic Colitis: Experience from Edinburgh

Figures & data

Table 1 List of Differential Diagnoses of Microscopic Colitis

Common Differential Diagnoses of Chronic Non-Bloody Watery Diarrhoea
Microscopic colitis (LC or CC) Irritable bowel syndrome (IBS) Bile acid malabsorption Crohn’s disease (CD) Gastroenteritis Coeliac disease Medications, eg, metformin Colonic neoplasia Post-radiation diarrhoea Small bowel bacterial overgrowth Hyperthyroidism HIV

Figure 1 Calprotectin levels measured in collagenous and lymphocytic colitis.

Figure 2 7-α Cholestenone levels measured in collagenous and lymphocytic colitis.

Table 2 Summary of Research Evaluating the Clinical Effectiveness of Faecal Calprotectin in MC

Limburg et al^Citation14	FCP was higher in those with colorectal inflammation and chronic colitis than in those with no colonic inflammation.
Von Arnim et al^Citation15	17 patients with active MC and 20 with IBS had FCP levels prospectively reviewed. Higher FCP levels were found within the MC group.
Wildt et al^Citation16	Higher FCP in active CC, compared with quiescent CC and a control group, who did not have MC.
Larsson et al^Citation17	No significant differences between the levels of FCP amongst 15 patients with active MC compared to a control group.
Batista et al^Citation18	34 MC patients were compared with a control group of 60 whom had functional watery diarrhoea. Mean FCP values were; 175 in MC group, and 28 in the control.

Table 3 Sample of Previous Research Evaluating the Association of BAM in MC and/Or the Role of 7-α Cholestenone in Detecting BAM

Ung et al^Citation21	Using SeHCAT, BAM was common in a CC cohort (n=12/27, 44%)
Ung et al^Citation22	BAM less common in LC compared with CC.
Rasmussen^Citation23	Bile acid diarrhoea accompanied 41% of CC and 29% of LC cases.
Brydon et al^Citation24	Identified a similar effectiveness of 7αC to that of SeHCAT.
Fernández-Bañares^Citation25	BAM common in both MC (43.1%, n=22/51) and unexplained functional chronic diarrhoea (75%, n=24/32).

Table 4 Summary Comparing the Findings Between Collagenous and Lymphocytic Colitis

	Collagenous Colitis	Lymphocytic Colitis
Faecal Calprotectin
Number of patients tested	147	14
Elevated (>50μg/g)	111 (75.5%, n=111/147)	8 (57.1%, n=8/14)
7-α Cholestenone
Number of patients tested	140	20
Elevated (>22ng/mL)	16 (11.4%, n=16/140)	5 (25%, n=5/20)

Limburg PJ, Ahlquist DA, Sandborn WJ, et al. Fecal calprotectin levels predict colorectal inflammation among patients with chronic diarrhea referred for colonoscopy. Am J Gastroenterol. 2000;95(10):2831–2837. doi:10.1111/j.1572-0241.2000.03194.x

 PubMed Web of Science ®Google Scholar

von Arnim WT, Ganzert C, Schulz C, Malfertheiner, P. Fecal calprotectin: a marker for clinical differentiation of microscopic colitis and irritable bowel syndrome. Clin Exp Gastroenterol. 2016;9:97–103. doi:10.2147/CEG.S97701

 PubMed Web of Science ®Google Scholar

Wildt S, Nordgaard-Lassen I, Bendtsen F, Rumessen JJ. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol. 2007;19(7):567–574. doi:10.1097/MEG.0b013e328058ed76

 PubMed Web of Science ®Google Scholar

Larsson JK, Sjoberg K, Vigren L, Benoni C, Toth E, Olesen M. Chronic non-bloody diarrhoea: a prospective study in Malmo, Sweden, with focus on microscopic colitis. BMC Res Notes. 2014;7:236. doi:10.1186/1756-0500-7-236

 PubMedGoogle Scholar

Batista L, Ruiz L, Ferrer C, Zabana Y, Aceituno M, Arau B. Usefulness of fecal calprotectin as a biomarker of microscopic colitis in a cohort of patients with chronic watery diarrhoea of functional characteristics. Dig Liver Dis. 2019;S1590-8658(19)30686.

 Google Scholar

Ung KA, Gilberg R, Kilander A, Abrahamsson H. Role of bile acids and bile acid binding agents in patients with collagenous colitis. Gut. 2000;46(2):170–175. doi:10.1136/gut.46.2.170

 PubMed Web of Science ®Google Scholar

Ung KA, Kilander A, Willen R, Abrahamsson H. Role of bile acids in lymphocytic colitis. Hepatogastroenterology. 2002;49(44):432–437.

 PubMed Web of Science ®Google Scholar

Rasmussen MA, Munck LK. Systematic review: are lymphocytic colitis and collagenous colitis two subtypes of the same disease – microscopic colitis? Ailment Pharmacol Ther. 2012;36(2):79–90. doi:10.1111/j.1365-2036.2012.05166.x

 PubMed Web of Science ®Google Scholar

Brydon WG, Culbert P, Kingstone K, et al. An evaluation of the use of serum 7-alpha-hydroxycholestenone as a diagnostic test of bile acid malabsorption causing watery diarrhea. Can J Gastroenterol. 2011;25(6):319–323. doi:10.1155/2011/701287

 Web of Science ®Google Scholar

Fernández-Bañares F, Esteve M, Salas A, et al. Bile acid malabsorption in microscopic colitis and in previously unexplained functional chronic diarrhea. Dig Dis Sci. 2001;46(10):2231–2238. doi:10.1023/A:1011927302076

 PubMed Web of Science ®Google Scholar