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Decreased Fecal Calprotectin Levels in Cystic Fibrosis Patients After Antibiotic Treatment for Respiratory Exacerbation

Schnapp, Zeev*,†; Hartman, Corina*,†,‡; Livnat, Galit*,†,§,||; Shteinberg, Michal†,§,||; Elenberg, Yigal*,†,‡

Journal of Pediatric Gastroenterology and Nutrition: February 2019 - Volume 68 - Issue 2 - p 282–284
doi: 10.1097/MPG.0000000000002197
Original Articles: Pancreatology

Objectives: In all patients with cystic fibrosis (CF), gastrointestinal (GI) tract CF transmembrane conductance regulator dysfunction occurs early in life. The identical pathophysiological triad of obstruction, infection, and inflammation causes disease of the airways and in the intestinal tract (CF enteropathy). Mucus accumulation within GI tract is a niche for abnormal microbial colonization, leading to dysbiosis. Fecal calprotectin (FC) is a neutrophil cytosolic protein released during apoptosis and necrosis and reflects inflammatory status. Systemic antibiotic treatment for pulmonary exacerbations has been shown to improve systemic inflammatory markers and serum and sputum calprotectin. Antibiotic treatment aimed at pulmonary complaints may improve GI tract inflammatory status. We hypothesized that high levels of FC present during pulmonary exacerbation are due, in part, to multiorgan dysbiosis and thus should diminish with systemic antibiotic treatment.

Methods: This prospective pilot study enrolled 14 patients with CF, with no current GI symptoms. FC levels and lung function were measured at the beginning and end of systemic antibiotic treatment.

Results: Compared to preantibiotic treatment baseline values, end of treatment FC levels declined significantly after antibiotic treatment, P = 0.004 and similarly, there was significant improvement in forced expiratory volume in 1 second, P = 0.002.

Conclusions: High levels of FC during respiratory exacerbation may reflect a systemic exacerbation rather than solely pulmonary. Antibiotic treatment lowered the FC levels possibly by its impact on the intestinal microbiome.

*Department of Pediatrics, Lady Davis Carmel Medical Center

the B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology

Pediatric Gastroenterology Unit

§Pediatric Pulmonology Unit and CF Center

||Pulmonology Institute, Lady Davis Carmel Medical Center, Haifa, Israel.

Address correspondence and reprint requests to Zeev Schnapp, MD, Department of Pediatrics, Lady Davis Carmel Medical Center, Michal 7 st., Haifa, Israel (e-mail:

Received 1 August, 2018

Accepted 20 October, 2018

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,