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Evaluation of Mucosal Healing in Ulcerative Colitis by Fecal Calprotectin Vs. Fecal Immunochemical Test

Takashima, Shiho, MD1; Kato, Jun, MD2; Hiraoka, Sakiko, MD1; Nakarai, Asuka, MD1; Takei, Daisuke, MD1; Inokuchi, Toshihiro, MD1; Sugihara, Yuusaku, MD1; Takahara, Masahiro, MD1; Harada, Keita, MD3; Okada, Hiroyuki, MD3; Tanaka, Takehiro, MD4; Yamamoto, Kazuhide, MD1

American Journal of Gastroenterology: June 2015 - Volume 110 - Issue 6 - p 873–880
doi: 10.1038/ajg.2015.66
ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASE
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OBJECTIVES: We previously showed that a quantitative fecal immunochemical test (FIT) can predict mucosal healing (MH) in ulcerative colitis (UC). Fecal calprotectin (Fcal) has also been reported as an important biomarker of UC activity. The aim of this study was to compare the predictive ability of these two fecal markers for MH in UC.

METHODS: FIT and Fcal were examined in stool samples from consecutive UC patients who underwent colonoscopy. Mucosal status was assessed via the Mayo endoscopic subscore (MES).

RESULTS: In total, 105 colonoscopies in 92 UC patients were evaluated in conjunction with the FIT and Fcal results. Both FIT and Fcal results were significantly correlated with MES (Spearman’s rank correlation coefficient: 0.61 and 0.58, respectively). The sensitivity and specificity of the FIT values (<100 ng/ml) for predicting MH (MES 0 alone) were 0.95 and 0.62, respectively, whereas those of Fcal (<250 μg/g) were 0.82 and 0.62, respectively. The sensitivities became similar when MH was defined as MES 0 or 1 (0.86 vs. 0.86). Although the predictability of MH evaluated by the area under the receiver operating characteristics curve was similar for the two fecal markers (FIT 0.83 vs. Fcal 0.82 for MES 0 alone), the FIT results were relatively robust regardless of the cutoff value selected.

CONCLUSIONS: Both FIT and Fcal can efficiently predict MH in UC, but FIT appears to be more sensitive than Fcal for predicting MES 0 alone.

1Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

2Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

3Department of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

4Department of Pathology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Correspondence: Sakiko Hiraoka, MD, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. E-mail: sakikoh@cc.okayama-u.ac.jp

Received 18 September 2014; accepted 03 February 2015

Guarantor of the article: Sakiko Hiraoka, MD.

Specific author contributions: Design and conduct of the clinical trial contributing data to these analyses: Shiho Takashima, Jun Kato, Sakiko and Hiraoka; data collection and analysis: Asuka Nakarai, Daisuke Takei, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada, and Kazuhide Yamamoto; histological evaluation: Takehiro Tanaka. All authors provided critical content review and final approval of the manuscript.

Financial support: None.

Potential competing interests: None.

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg

© The American College of Gastroenterology 2015. All Rights Reserved.
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