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Limitations of Fecal Calprotectin At Diagnosis in Untreated Pediatric Crohn's Disease

Shaoul, Ron MD1; Sladek, Marlgozata MD, PhD2; Turner, Dan MD, PhD3; Paeregaard, Anders MD4; Veres, Gabor MD5; Wauters, Gigi Veereman MD, PhD6; Escher, Johanna MD, PhD7; Dias, Jorge Amil MD, PhD8; Lionetti, Paolo MD, PhD9; Staino, Annamaria MD, PhD10; Kolho, Kaija Leena MD, PhD11; de Ridder, Lissy MD, PhD7; Nuti, Federica MD12; Cucchiara, Salvatore MD, PhD12; Sheva, Orit PhD13; Levine, Arie MD13and the ESPGHAN Porto IBD Group

doi: 10.1002/ibd.21875
Original Article: Original Clinical Articles

Background: Fecal Calprotectin (FC) is a validated screening test for intestinal inflammation in Crohn's disease (CD). The objective of the study was to prospectively evaluate the limitations of FC for identifying CD in newly diagnosed untreated pediatric patients and to assess the association of FC levels with disease location and serum inflammatory markers.

Methods: Consecutive children with new onset untreated CD participating in the ongoing ESPGHAN GROWTH CD study were evaluated at diagnosis for disease activity, extent, C-reactive protein (CRP), and FC.

Results: In all, 60 children met the inclusion criteria (mean age 12.6 ± 4.6 years,), 25 (42%) with mild disease, 17 (28%) moderate disease, and 18 (30%) severe disease. Twenty-seven (45%) had small bowel disease only. Median FC levels did not differ between children with small bowel only (2198 μg/g interquartile range [IQR] 696–2400) and those with colonic involvement (with or without small bowel disease; 2400 μg/g (IQR 475–2400) (P = 0.76). FC was elevated in 95% of patients, in comparison to CRP (86%) and erythrocyte sedimentation rate (ESR) (83%). Three children (5%) who had normal calprotectin levels also had low or normal CRP and/or ESR. There was no correlation between calprotectin levels and either the pediatric CD activity index (r = −0.11; P = 0.94) or physicians global assessment.

Conclusions: FC levels in active disease confined to the small bowel were elevated in the vast majority of children and site of disease was not a confounding factor in this setting. Patients with low FC had a trend toward low levels of inflammatory markers as well. We did not find a significant correlation between FC and clinical indices of activity (Inflamm Bowel Dis 2012)

1 Pediatric Gastroenterology Unit, Rambam Medical Center, Technion, Faculty of Medicine, Haifa, Israel

2 Pediatric Gastronterology Unit, American Hospital, Krakow, Poland

3 Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel

4 Department Pediatrics, H:S Hvidovre Hospital, Hvidovre, Denmark

5 1st Dept. of Pediatrics, Semmelweis University, Budapest, Hungary

6 Pediatric Gastroenterology Unit, University Hospital UZ Brussels, Belgium

7 Pediatric Gastroenterology Unit, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands

8 Department pediatrics, Hospital, S. Joao, Porto, Portugal

9 Pediatric Gastroenterology Unit, Meyer Childrens Hospital, Florence, Italy

10 Dept. of Pediatrics, University of Naples “Federico II” Naples, Italy

11 Children's Hospital, University of Helsinki, Helsinki, Finland

12 Department Pediatrics, La Sapienza Hospital, Rome

13 Pediatric Gastroenterology Unit, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel

Reprints: Arie Levine, MD, Pediatric Gastroenterology Unit, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, POB 5 Holon, Israel


Received 24 July 2011; Accepted 3 August 2011

Published online 24 January 2012 in Wiley Online Library (

© Crohn's & Colitis Foundation of America, Inc.
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