Faecal calprotectin in children with clinically quiescent inflammatory bowel disease

Abstract

Objective. The use of faecal calprotectin as a surrogate marker for intestinal inflammation is emerging. However, the data on faecal calprotectin during maintenance therapy in children with inflammatory bowel disease, IBD, are sparse. Our aim was to study faecal calprotectin levels in paediatric IBD during clinically quiescent disease and to investigate if high levels were associated with a flare-up of the disease. Subjects and methods. Faecal calprotectin level was measured in 72 children with paediatric IBD in clinical remission (median age 13 years). Of these, 37 children had been in clinical remission for more than a year, 20 for 6–12 months and 15 for 3 to <6 months. The clinical outcome of the patients was followed up to the first relapse or up to 12 months. Results. When in clinical remission, 35% (25/72) of the children had normal faecal calprotectin (<100 μg/g) and 13% (9/72) a very high level (>1000 μg/g) while not reporting symptoms. A clinical relapse occurred in 35% (25/72) during the subsequent 12 months. When in clinical remission, the predictive value of faecal calprotectin for an overt relapse was low ranging from 0.396 to 0.429 for faecal calprotectin values >100 μg/g or >1000 μg/g, respectively. The negative predictive value was 0.75 for values <100 μg/g. Conclusions. In paediatric IBD, subjective symptoms and clinical assessment associate poorly with the levels of faecal calprotectin. During maintenance medication in colonic disease, the probability of staying in clinical remission for a subsequent year is high if faecal calprotectin value is low.

Key Words::

• Crohn's disease
• faecal markers
• paediatric IBD
• ulcerative colitis

Acknowledgements

We thank Ms. Sari Honkanen and Anne Nikkonen, and Marianne Sidoroff, M.D. for assistance in gathering the patient data. Dr. Ulrika Fagerberg-Lorenzon is thanked for stimulating discussions. The study was supported by the Finnish Pediatric Research Foundation, the Päivikki and Sakari Sohlberg Foundation, Mary and George C Ehrnrooth Foundation, Orion-Farmos Research Foundation, and the Helsinki University Central Hospital Research Fund.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.