The optimal goal for IBD treatment, and faecal calprotectin can tell when is has been achieved!
Many IBD patients are in clinical remission and have normal CRP, but still have ongoing inflammation (Siegmund B et al. Internist 2010;51:1492-1498) which is reflected by increased faecal calprotectin; such patients have increased risk of relapse within a few months (Tibble JA et al. Gastroenterology 2000;119:15-22), and some newly diagnosed patients already have intestinal strictures as a result of inflammation during several years.
If mucosal healing can be achieved, the risk of relapse and need for major abdominal surgery will be reduced (Schnitzler F et al. Inflamm Bowel Dis 2009;15:1295-1301; Björkesten CG et al. Inflamm Bowel Dis. 2010, Sep 21).
Normalization of calprotectin levels means that mucosal healing has been achieved (Røseth et al. Digestion 1997;58:176-180).
Several studies have now concluded that mucosal healing should be the optimal treatment goal, even if it may be difficult to achieve in some patients. The risk and severity of side effects to treatment should be balanced against the risk of continued inflammation, severe clinical relapse and complications.
The importance of achieving mucosal healing has been focused in many scientific reviews and articles:
Reviews: Devlin SM, Panaccione R, Med Clin North Am. 2010;94:1-18; Pineton de Chambrun G et al. Nat Rev Gastroenterol Hepatol 2010; 7:15-29; Lichtenstein GR , Rutgeerts P, Inflamm Bowel Dis. 2010;16:338-346; Smith MA et al. Pharmarcogenetics, 2010;11:421-437; Lin MV et al. Expert Rev Gastroenterol Hepatol. 2010;4:167-180; Strauch U, Schölmerich J. Expert Opin Emerg Drugs, 2010;15:309-322; Isaacs KL, Dig Dis 2010;28:548-555; Schwartz M, Regueiro M, Curr Gastroenterol Rep. 2010 Nov 2; Ha C, Kornbluth A, Curr Gastroenterol Rep. 2010;12:471-478.
Articles: Fagerberg et al. J Pediatr Gastroenterol Nutr. 2007;45:414-420; Rutgeerts P et al. Gastroenterology, 2009;136:1182-1197; Jalocha L et al. Pol Merkur Lekarski. 2009;26:554-555; Baert F et al. Gastroenterology, 2010;138:463-468; Allez M, Lémann M, World J Gastroenterol. 2010;16:2626-2632; Lasson A, Läkartidningen, 2010;107:2645-2649.)
The gold standard for assessment of disease activity and mucosal healing is endoscopy with histology, but due to costs, risks and complexity, it cannot be part of day-to-day care.
IBD patients are now demanding a test to monitor the response to treatment of their disease, pointing to the importance of regular blood sugar testing that has improved the health and life expectancy of diabetics. Today even testing for sugar in urine is insufficient as a way of monitoring diabetes; blood sugar is so much better. Patients ask the highly relevant question: why should IBD patients not have a similar option?
We are happy to state that our ELISA kit can be that option!
The literature shows good correlation between IBD disease activity and faecal calprotectin levels, and normalization means that mucosal healing has probably been achieved. If levels are still high, in particular above 200 mg/kg, change in treatment may be needed, and if in doubt, only about 0.1 gram of new sample is needed for retesting. Most patients happily prefer to provide such a stool sample rather than endoscopy.
The use of our Calprotectin test has improved IBD patient care significantly; at the same time, expenses are saved for patients and health insurance systems. One test typically costs less than 5 % of an endoscopy and biopsy; in addition, it is non-invasive, pain-free and carries no complication risk in contrast to endoscopy and biopsy. Details of sample collection and handling is described elsewhere on our web site.
Li XG, Lv YM, Gu F, Yang XL., Department of Gastroenterology, Peking University Third May 9, 2015
December 19, 2018