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Fecal Hemoglobin and Calprotectin Are Equally Effective in Identifying Patients with Inflammatory Bowel Disease with Active Endoscopic Inflammation

Mooiweer, Erik MD; Fidder, Herma H. MD, PhD; Siersema, Peter D. MD, PhD; Laheij, Robert J. F. MD, PhD; Oldenburg, Bas MD, PhD

doi: 10.1097/01.MIB.0000438428.30800.a6
Original Clinical Articles

Background: Fecal calprotectin can be used as a noninvasive tool to assess inflammation in patients with inflammatory bowel disease (IBD). However, the diagnostic accuracy of calprotectin is modest, and therefore additional markers are needed. We compared the efficacy of fecal hemoglobin and calprotectin as markers for endoscopic inflammation in patients with IBD.

Methods: Consecutive patients with Crohn's disease or ulcerative colitis scheduled for surveillance colonoscopy collected a stool sample before bowel preparation. Experienced endoscopists assessed the presence of inflammation in each colonic segment. Fecal calprotectin and hemoglobin were analyzed with an enzyme-linked immunosorbent assay. Receiver operator characteristic statistics were used to determine cutoff values for calprotectin and hemoglobin.

Results: A total of 176 surveillance colonoscopies were performed in 164 patients, of which 83 patients had Crohn's disease, 74 had ulcerative colitis, and 7 IBD-unclassified. Median (interquartile range) calprotectin and hemoglobin concentrations were 137 mg/kg (interquartile range, 33–494) and 0.51 μg/g (interquartile range, 0.18–8.50), respectively. For calprotectin, a cutoff value of 140 mg/kg predicted endoscopic inflammation with 86% sensitivity, 72% specificity, 64% positive predictive value, 90% negative predictive value, and an area under the curve of 0.87. For hemoglobin, a cutoff value of 1.51 μg/g indicated endoscopic inflammation with 74% sensitivity, 84% specificity, 72% positive predictive value, 84% negative predictive value, and an area under the curve of 0.81. Combining both tests did not increase the predictive accuracy substantially compared with calprotectin or hemoglobin alone (area under the curve, 0.88).

Conclusions: Fecal hemoglobin can identify patients with IBD with active inflammation with a predictive accuracy similar to calprotectin.

Article first published online 26 December 2013

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.

Reprints: Erik Mooiweer, MD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands (e-mail:

Supported by an unrestricted grant from MSD BV and an unrestricted grant from Ferring BV. Calprotectin and hemoglobin analyses were kindly provided by R-Biopharm.

B. Oldenburg is a consultant for Abbvie BV, MSD BV, and Ferring BV. H. H. Fidder received a research grant from Abbvie BV, and she is a consultant for Abbvie BV and MSD BV. The remaining authors have no conflicts of interest to disclose.

Received September 30, 2013

Accepted November 09, 2013

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