Updates on calprotectin and IBD—where to look?

Endoscopy with biopsy is the gold standard for detection and monitoring of intestinal inflammation. Meanwhile, the use of surrogate markers (biomarkers) enables gastroenterologists to reduce costs and inconvenience in the management of intestinal disorders by eliminating the need for invasive procedures. Hence, efficient application of biomarkers for disease detection and assessment of treatment response is critical to cost-effective control of gastrointestinal disease. In this setting, elevated levels of C-reactive protein are a general sign of inflammation and widely used in combination with faecal calprotectin for the detection and monitoring of inflammatory bowel disease (IBD).

Calprotectin is a protein found particularly in neutrophils but also in monocytes. Neutrophil disruption results in the release of calprotectin, although some of it is actively secreted.¹ Detection of calprotectin in stool indicates neutrophil migration and infiltration in the intestinal tract, including the gut mucosa. Resisting enzymatic degradation, calprotectin is highly stable and can be detected in stool kept at room temperature for at least 7 days.² Calprotectin levels in stool (usually expressed as µg/g of faeces) correlate well with endoscopic scoring systems for IBD, such as the ulcerative colitis endoscopic index of severity (UCEIS) and Crohn’s disease endoscopic index of severity (CDEIS), and may even perform better than the Crohn’s Disease Activity Index (CDAI).²

In his comprehensive Gastroenterology review on biomarkers of inflammation in IBD, Bruce Sands summarized the applicability and relevance of using faecal calprotectin to distinguish between IBD and irritable bowel syndrome, and also for categorizing IBD activity, ascertaining response to treatment and predicting clinical relapse.³

Reviews in leading journals are, of course, an excellent tool for updating yourself on state-of-the-art knowledge within a given area; however, the plethora of material present in the UEG Education Library may also prove highly useful. For example, searching the library for calprotectin currently returns no fewer than 338 hits, including 214 conference abstracts, 64 presentations, 55 posters, and 4 syllabus contributions submitted by leading gastroenterologists and rising stars. Among the four syllabus contributions, there is one specifically focused on calprotectin by Christoph Beglinger; for this particular syllabus contribution you have the option to read the pdf or view the associated presentation from UEG Week 2013.⁴

If you’re looking for the latest progress on the use of calprotectin, filtering your 338 hits by year narrows the results to 59 items for 2015. Among these hits, there are three abstracts from UEG Week 2015 on a smartphone-based calprotectin home test—a technology that was developed to try to eliminate the need for patients to bring stool samples to the clinic for analysis and to allow them to play a more active role in their disease management.

Another great place to search for relevant information is in the ‘Standards and Guidelines’ that are also now available via the UEG Education Library. There are currently 17 IBD standards and guidelines available for you to access. One of these articles is “Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 1: Definitions and diagnosis”, which you can use to update yourself on consensus opinion on the application of calprotectin.⁵

Finally, the UEG 24/7 pathway gives you access to all core scientific lectures from UEG Week 2015 in Barcelona. Here, you have the option to select the IBD pathway or you can narrow the results by entering the word biomarker in the filter by title’ search box. Any interesting hits?

References:

1. Ikhtaire S, et al. Fecal calprotectin: its scope and utility in the management of inflammatory bowel disease. J Gastroenterol 2016; 51: 434–446. http://link.springer.com/article/10.1007%2Fs00535-016-1182-4
2. Dhar A. Faecal calprotectin—ready for prime time? Frontline Gastroenterol 2015; 6: 11–13. http://fg.bmj.com/content/6/1/11.full?sid=6d4911d3-7396-4419-90f3-2ab22e6ad224
3. Sands BE. Biomarkers of inflammation in inflammatory bowel disease. Gastroenterology 2015; 149: 1275–1285. http://www.gastrojournal.org/article/S0016-5085(15)00938-5/abstract
4. “Utility of faecal markers in IBD clinical practice” syllabus contribution at UEG Week 2013 https://www.ueg.eu/education/document/utility-of-faecal-markers-in-ibd-clinical-practice/101750/
5. Dignass A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 1: Definitions and diagnosis. J Crohn’s Colitis 2012; 6: 965–990. https://www.ueg.eu/education/document/second-european-evidence-based-consensus-on-the-diagnosis-and-management-of-ulcerative-colitis-part-1-definitions-and-diagnosis/125500/