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Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease
  1. F Costa1,
  2. M G Mumolo1,
  3. L Ceccarelli1,
  4. M Bellini1,
  5. M R Romano1,
  6. C Sterpi1,
  7. A Ricchiuti1,
  8. S Marchi1,
  9. M Bottai2
  1. 1Department of Internal Medicine, Section of Gastroenterology, University of Pisa, Pisa, Italy
  2. 2Arnold School of Public Health, University of South Carolina, Columbia SC, USA
  1. Correspondence to:
    Dr F Costa
    Dipartimento di Medicina Interna-SO di Gastroenterologia, Universita’ di Pisa, Ospedale S Chiara, Via Roma, 67-56122 PISA, Italy;


Background and aims: The clinical course of inflammatory bowel disease is characterised by a succession of relapses and remissions. The aim of our study was to assess whether the predictive value of faecal calprotectin—a non-invasive marker of intestinal inflammation—for clinical relapse is different in ulcerative colitis (UC) and Crohn’s disease (CD).

Methods: Seventy nine consecutive patients with a diagnosis of clinically quiescent inflammatory bowel disease (38 CD and 41 UC) were followed for 12 months, undergoing regular clinical evaluations and blood tests. A single stool sample was collected at the beginning of the study from each patient and the calprotectin concentration was assessed by a commercially available enzyme linked immunoassay.

Results: In CD, median calprotectin values were 220.1 μg/g (95% confidence interval (CI) 21.7–418.5) in those patients who relapsed during follow up, and 220.5 μg/g (95% CI 53–388) in non-relapsing patients (p = 0.395). In UC, median calprotectin values were 220.6 μg/g (95% CI 86–355.2) and 67 μg/g (95% CI 15–119) in relapsing and non-relapsing patients, respectively (p<0.0001). The multivariate Cox (proportional hazard) regression model, after adjustment for possible confounding variables, showed a twofold and 14-fold increase in the relapse risk, respectively, in those patients with CD and UC in clinical remission who had a faecal calprotectin concentration higher than 150 μg/g.

Conclusions: Faecal calprotectin proved to be an even stronger predictor of clinical relapse in UC than in CD, which makes the test a promising non-invasive tool for monitoring and optimising therapy.

  • CRP, C reactive protein
  • CD, Crohn’s disease
  • CDAI, Crohn’s disease activity index
  • ESR, erythrocyte sedimentation rate
  • IBD, inflammatory bowel disease
  • NPV, negative predictive value
  • PPV, positive predictive value
  • ROC, receiver operating characteristic
  • UC, ulcerative colitis
  • UCAI, ulcerative colitis activity index
  • calprotectin
  • ulcerative colitis
  • Crohn’s disease
  • inflammatory bowel disease
  • intestinal inflammation

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  • Conflict of interest: None declared.

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