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Both fecal calprotectin and fecal immunochemical tests are useful in children with inflammatory bowel disease

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Abstract

Background

Noninvasive biomarkers of intestinal inflammation can reduce the number of endoscopies in children with inflammatory bowel disease (IBD). This study aimed to prospectively investigate the usefulness of fecal calprotectin (FCP) and fecal immunochemical test (FIT) in pediatric IBD.

Methods

Patients aged 6–17 years who underwent ileocolonoscopy for established or suspected IBD were eligible for this study. Fecal samples for FCP and FIT were collected before colonoscopy.

Results

A total of 251 samples were analyzed: 88 from ulcerative colitis (UC), 74 from Crohn’s disease (CD), 75 from healthy controls (HC), and 14 from children with functional gastrointestinal disorders and normal colonoscopy (NC). At IBD diagnosis, both FCP and FIT were significantly higher in the newly diagnosed UC/CD group than in the HC/NC group (P < 0.001). The optimal cutoffs of FCP and FIT to predict IBD diagnosis were 217 mg/kg and 87 ng/mL, respectively. Patients without mucosal healing (MH) showed higher FCP and FIT than those with MH in both UC and CD (P < 0.001). The FCP increased exponentially as the endoscopic activity score increased. The optimal cutoff values of FCP and FIT for predicting MH were 161 mg/kg and 106 ng/mL for UC and 367 mg/kg and 57 ng/mL for CD, respectively. FCP showed better specificity than the FIT. Patients with CD and normal ileocolonoscopy had elevated FCP during active small intestinal inflammation.

Conclusions

Both FCP and FIT correlate well with endoscopic activity in pediatric patients with IBD. The FCP is a superior marker for predicting MH.

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Acknowledgements

We express our sincere gratitude to Dr. Sachiko Nishina (Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan) for their valuable assistance in collecting fecal samples. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work was supported, in part, by a Grant-in-Aid from the National Center for Child Health and Development from the Ministry of Health, Labour and Welfare of Japan (No. 2019A-3), by Health and Labour Sciences Research Grants for studies on intractable diseases from the Ministry of Health, Labour and Welfare of Japan (No. 20FC1037), and by a research grant from Nippon Kayaku in stool bacterial cultures. Thermo Fisher Scientific also supported this study for fecal calprotectin measurements.

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Authors and Affiliations

  1. Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hirotaka Shimizu, Ichiro Takeuchi & Toshiaki Shimizu

  2. Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Hirotaka Shimizu, Takuro Sato, Masaaki Usami, Ichiro Takeuchi & Katsuhiro Arai

  3. Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan

    Ryo Ebana, Tomoko Hara, Masashi Yoshida & Itaru Iwama

  4. Department of Pediatrics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Takahiro Kudo & Kenji Hosoi

  5. Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8543, Japan

    Hiroshi Nakase

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  1. Hirotaka Shimizu
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Corresponding author

Correspondence to Hirotaka Shimizu.

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Conflict of interest

Hiroshi Nakase has received support from AbbVie GK., Kissei Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co.,Ltd., Mitsubishi Tanabe Pharma Corporation, Janssen Pharmaceutical K.K, Takeda Pharmaceutical Co.,Ltd., Pfizer Inc, Celgene Corporation., EA Pharma Co.,Ltd., Zeria Pharmaceutical CO.,Ltd., Mochida Pharmaceutical Co.,Ltd., Nippon Kayaku Co.,Ltd., Daiichi Sankyo Company, Limited., JIMRO Co.,Ltd., as well as grants for commissioned/joint research from Hoya Group Pentax Medical, Mitsubishi Tanabe Pharma Corporation, Pfizer Inc, AbbVie GK., Mochida Pharmaceutical Co.,Ltd. Katsuhiro Arai received honoraria for consulting and lecture from EA Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, and a research grant from AstraZeneca K.K. Toshiaki Shimizu is an endowed chair of Taiko Pharmaceutical and has received a research grant from the Food Science Institute Foundation and a scholarship grant from JCR Pharmaceuticals Co., Ltd. Other authors declare that they have no conflict of interests.

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Shimizu, H., Ebana, R., Kudo, T. et al. Both fecal calprotectin and fecal immunochemical tests are useful in children with inflammatory bowel disease. J Gastroenterol 57, 344–356 (2022). https://doi.org/10.1007/s00535-022-01856-w

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  • DOI: https://doi.org/10.1007/s00535-022-01856-w

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