Intestinal Research

Original Articles

Miscellaneous

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study: Antonio Tursi, Daniele Piovani, Giovanni Brandimarte, Francesco Di Mario, Walter Elisei, Marcello Picchio, Gisella Figlioli, Gabrio Bassotti, Leonardo Allegretta, Maria Laura Annunziata, Mauro Bafutto, Maria Antonia Bianco, Raffaele Colucci, Rita Conigliaro, Dan L. Dumitrascu, Ricardo Escalante, Luciano Ferrini, Giacomo Forti, Marilisa Franceschi, Maria Giovanna Graziani, Frank Lammert, Giovanni Latella, Daniele Lisi, Giovanni Maconi, Debora Compare, Gerardo Nardone, Lucia Camara de Castro Oliveira, Chaves Oliveira Enio, Savvas Papagrigoriadis, Anna Pietrzak, Stefano Pontone, Ieva Stundiene, Tomas Poškus, Giuseppe Pranzo, Matthias Christian Reichert, Stefano Rodino, Jaroslaw Regula, Giuseppe Scaccianoce, Franco Scaldaferri, Roberto Vassallo, Costantino Zampaletta, Angelo Zullo, Erasmo Spaziani, Stefanos Bonovas, Alfredo Papa, Silvio Danese, DICA International Group; Intest Res 2025;23(1):96-106. Published online August 12, 2024; DOI: https://doi.org/10.5217/ir.2024.00046

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).
Methods
An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.
Results
Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]_constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04–1.27; P=0.004; and HR_diarrhea =1.14; 95% CI, 1.03–1.26; P=0.014, respectively).
Conclusions
In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

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IBD

Intestinal ultrasonography and fecal calprotectin for monitoring inflammation of ileal Crohn’s disease: two complementary tests: José María Paredes, Tomás Ripollés, Ángela Algarra, Rafael Diaz, Nadia Moreno, Patricia Latorre, María Jesús Martínez, Pilar Llopis, Antonio López, Eduardo Moreno-Osset; Intest Res 2022;20(3):361-369. Published online March 15, 2022; DOI: https://doi.org/10.5217/ir.2021.00126

Abstract PDF PubReader ePub

Background/Aims
Tight control of inflammation and adjustment of treatment if activity persists is the current strategy for the management of Crohn’s disease (CD). The usefulness of fecal calprotectin (FC) in isolated involvement of the small intestine in CD is controversial. To assess the usefulness of FC to determine the inflammatory activity detected by intestinal ultrasonography (IUS) in ileal CD.
Methods
Patients with exclusively ileal involvement CD who underwent IUS and an FC were prospectively included. Simple ultrasound index was used to determine inflammatory activity. The usual statistical tests for comparison of diagnostic techniques were used.
Results
One hundred and five patients were included, IUS showed inflammatory activity in 59% of patients and complications in 18.1%. FC showed a significant correlation with IUS in the weak range (Spearman coefficient r=0.502; P<0.001); the area under the receiver operating characteristic curve was 0.79 (95% confidence interval, 0.70–0.88; P<0.001). The FC value that best reflected the activity in IUS was 100 μg/g with sensitivity, specificity, and positive and negative predictive values of 73.0%, 71.4%, 79.3% and 63.8%, respectively. There were no differences in FC concentration between patients with or without transmural complications. The addition of serum C-reactive protein to FC did not improve the ability to assess IUS activity.
Conclusions
FC has a significant correlation with IUS to monitor ileal CD activity. This correlation is weak and it does not allow assessing the presence of CD complications. Both tests should be used in conjunction for tight control of ileal CD. More studies on noninvasive tests in this location are needed.

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Fecal calprotectin, intestinal ultrasound, and their combination for the diagnosis of inflammatory bowel disease
Serge Dubian, Clara Yzet, Franck Brazier, Thierry Yzet, Vincent Hautefeuille, Catherine Decrombecque, Quentin Bocquillon, Nicolas Richard, Anthony Buisson, Jonathan Meynier, Mathurin Fumery
Clinics and Research in Hepatology and Gastroenterology.2025; 49(3): 102549. CrossRef
Clinical Trial: The Effects of Emulsifiers in the Food Supply on Disease Activity in Crohn's Disease: An Exploratory Double‐Blinded Randomised Feeding Trial
Jessica A. Fitzpatrick, Peter R. Gibson, Kirstin M. Taylor, Ellen J. Anderson, Antony B. Friedman, Zaid S. Ardalan, Rebecca L. Smith, Emma P. Halmos
Alimentary Pharmacology & Therapeutics.2025; 61(8): 1276. CrossRef
Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases—A Systematic Review
Vasile-Claudiu Mihai, Liliana Gheorghe, Ioana-Irina Rezuș, Alina Ecaterina Jucan, Mihaela-Cristiana Andronic, Otilia Gavrilescu, Mihaela Dranga, Andrei-Mihai Andronic, Cristina Cijevschi Prelipcean, Ciprian Rezuș, Cătălina Mihai
Diagnostics.2024; 14(8): 812. CrossRef
The intestinal ultrasound role in inflammatory bowel disease in clinical practice and a critical appraisal of the current guidelines (mini-review)
Sarah El-Nakeep
The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Intestinal Ultrasonography as an Alternative to Fecal Calprotectin to Monitor Patients with Crohn’s Disease: Experience from a Novice Sonographer
Kelly Mathieu, Jérémy Junda, Régine Minet-Quinard, Dilek Coban, Marie Dodel, Bruno Pereira, Anthony Buisson
Digestive Diseases and Sciences.2024; 69(9): 3402. CrossRef
Intestinal ultrasound for follow-up after 24 weeks of biological therapy in inflammatory bowel disease patients: an Egyptian center experience during the COVID-19 pandemic
Sarah El-Nakeep, Ehab Nashaat, Fatma Alsherif, Mohamed Magdy Salama
Egyptian Journal of Radiology and Nuclear Medicine.2024;[Epub] CrossRef
Assessing Active Bowel Inflammation in Crohn's Disease Using Intestinal Ultrasound
Myung‐won You, Sung Kyoung Moon, Yong Dae Lee, Shin Ju Oh, Seong Jin Park, Chang Kyun Lee
Journal of Ultrasound in Medicine.2023; 42(12): 2791. CrossRef
Standardizing Endoscopic Reporting in Patients with IBD: JEDII™ to the Rescue?
Sara Massironi, Alice Laffusa, Tommaso Lorenzo Parigi, Silvio Danese
Digestive Diseases and Sciences.2023; 68(12): 4287. CrossRef
Application of transabdominal ultrasound in Crohn’s disease
Wei-Jie Chen, Lei-Lei Luo, Zhi-Xing Dong, Jing Wu, Xing-Xing Gu, Zhao-Lian Bian
World Chinese Journal of Digestology.2022; 30(8): 364. CrossRef
Is radiological healing alone enough? ‘Can’t take my eyes off’ the mucosa
Su Hyun Park, Sang Hyoung Park
The Korean Journal of Internal Medicine.2022; 37(3): 551. CrossRef

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Perspective

IBD

Endoscopy for assessment of mucosal healing in ulcerative colitis: time bound or response guided?: Ajit Sood, Ramit Mahajan, Arshdeep Singh, Vandana Midha, Varun Mehta; Intest Res 2022;20(3):297-302. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00099

Abstract PDF PubReader ePub

The timing of colonoscopy in patients with active ulcerative colitis (UC) lacks coherence. The published guidelines and recommendations advocate time-bound colonoscopy in patients with active UC to assess for mucosal healing. However, the practice of performing colonoscopies at fixed time frames lacks reasoning. The time to achieve mucosal healing in UC is not uniform across the patient populations and is influenced by the disease severity and efficacy and time to therapeutic response of the drugs being used. Additionally, with the availability of sensitive noninvasive inflammatory biomarkers such as fecal calprotectin, that parallel the disease activity and correlate with mucosal healing, the notion of performing colonoscopy at fixed intervals sounds unjustifiable. The authors express their view that a response-guided colonoscopy (driven by normalization of clinical symptoms and inflammatory biomarkers), rather than a time-bound colonoscopy, would be more logical, apart from being cost-effective and patient-friendly.

Citations

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Applicability of colon capsule endoscopy for monitoring ulcerative colitis: a systematic review
Mathilde Simone Rasmussen, Lea Østergaard Hansen, Ulrik Deding, Mark Bremholm Ellebæk, Jens Kjeldsen, Thomas Bjørsum-Meyer
Scandinavian Journal of Gastroenterology.2025; 60(4): 336. CrossRef
Seeing Is Believing: Does Red Dichromatic Imaging (RDI) Predict Histological Remission and Clinical Outcomes in Ulcerative Colitis Patients?
Vedran Tomašić
Digestive Diseases and Sciences.2025;[Epub] CrossRef
Comments on Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial
Ji Eun Kim
Gut and Liver.2024; 18(1): 192. CrossRef
Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease
Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park
Intestinal Research.2024; 22(1): 75. CrossRef
A novel serum biomarker of endoscopic mucosal healing in inflammatory bowel disease
Hyoun Woo Kang
Intestinal Research.2024; 22(1): 3. CrossRef
Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023
Hsu-Heng Yen, Jia-Feng Wu, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin
Intestinal Research.2024; 22(3): 213. CrossRef
Histologic improvement predicts endoscopic remission in patients with ulcerative colitis
Ji Eun Kim, Minjee Kim, Min-Ji Kim, Eun Ran Kim, Sung Noh Hong, Dong Kyung Chang, Sang Yun Ha, Young-Ho Kim
Scientific Reports.2024;[Epub] CrossRef
Practical management of mild-to-moderate ulcerative colitis: an international expert consensus
Ferdinando D’Amico, Fernando Magro, Axel Dignass, Sameer Al Awadhi, Ana Gutierrez Casbas, Natália Sousa Freitas Queiroz, Grażyna Rydzewska, Byong Duk Ye, Zhihua Ran, Ailsa Hart, Vipul Jairath, Gionata Fiorino, Laurent Peyrin-Biroulet, Silvio Danese
Expert Review of Gastroenterology & Hepatology.2024; 18(8): 421. CrossRef
Predictive Value of PHRI for Recurrence within One Year after UC Treatment: A Retrospective Study
Kun Zhang, Jianlan Xie, Jianmin Zhao, Mei Jia
British Journal of Hospital Medicine.2024; : 1. CrossRef
Molecular Activity of Inflammation and Epithelial-Mesenchymal Transition in the Microenvironment of Ulcerative Colitis
Yu Kyung Jun, Nayoung Kim, Hyuk Yoon, Ji Hyun Park, Hyung Kyung Kim, Yonghoon Choi, Ji Ae Lee, Cheol Min Shin, Young Soo Park, Dong Ho Lee
Gut and Liver.2024; 18(6): 1037. CrossRef
Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study
Suh Hyun Choi, Won Eui Yoon, Seung Hyuk Kim, Hee Jun Myung, Seo Hyun Kim, Soon Oh So, Se Hun Kim, Hyun Mi Lee, Yeoun Jung Oh, Jeong Seop Moon, Tae Yeong Park, You Sun Kim
The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef

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Original Article

Inflammatory Bowel Diseases

The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis: Yujin Jeong, Seong Ran Jeon, Hyun Gun Kim, Jung Rock Moon, Tae Hee Lee, Jae Young Jang, Jun-Hyung Cho, Jun Seok Park, Heesu Park, Ki-hun Lee, Jin-Oh Kim, Joon Seong Lee, Bong Min Ko, Suyeon Park; Intest Res 2021;19(1):62-70. Published online May 8, 2020; DOI: https://doi.org/10.5217/ir.2019.09156

Abstract PDF PubReader ePub

Background/Aims
Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) can serve as biomarkers for diagnosing and assessing disease activity in ulcerative colitis (UC). We investigated their clinical significance in UC.
Methods
We analyzed 48 patients with UC who underwent measurement of fecal calprotectin (FC) and endoscopy and 96 age- and sex-matched healthy controls. NLR and PLR were compared between the patients and healthy controls. The endoscopic activity was divided into 2 groups: group 1 (mild to moderate inflammation) and group 2 (severe inflammation) according to the Mayo endoscopic subscore in UC.
Results
To diagnose UC, the optimal cutoff of NLR and PLR was 2.26 (sensitivity 54.2%; specificity 90.6%; positive likelihood ratio 5.778, 95% confidence interval [CI] 2.944–11.339; area under the curve [AUC] 0.774, 95% CI, 0.690–0.859) and 179.8 (sensitivity 35.4%; specificity 90.6%; positive likelihood ratio 3.778, 95% CI 1.821–7.838; AUC 0.654, 95% CI 0.556–0.753), respectively. The optimal cutoff to differentiate group 1 and group 2 was 3.44, 175.9, and 453 µg/g for NLR, PLR, and FC, respectively (sensitivity, 63.6% vs. 90.9% vs. 81.8%; specificity, 81.1% vs. 78.4% vs. 73.0%; positive likelihood ratio, 3.364 vs. 4.205 vs. 3.027; AUC, 0.714 vs. 0.897 vs. 0.813). PLR had the highest AUC and positive likelihood ratio.
Conclusions
NLR and PLR help differentiate patients with UC from healthy controls. NLR, PLR, and FC indicate endoscopic activity and may reflect intestinal mucosal conditions.

Citations

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Predictive Value of Albumin to Fibrinogen Ratio and CALLY Index for Diagnosis of Ulcerative Colitis and Mucosal Healing After Vedolizumab Treatment
Kairong Su, Sinan Xiao, Mei Wang, Kairuo Wang, Qing Fan, Sumei Sha, Yongli Cheng, Xin Liu, Haitao Shi
Journal of Inflammation Research.2025; Volume 18: 589. CrossRef
The ability of C-reactive protein-albumin ratio to predict disease activity in ulcerative colitis
Ibrahimhalil Dusunceli, Zeynep Gok Sargin, Umut Celik, Fatih Sargin
Biomarkers in Medicine.2025; 19(4): 113. CrossRef
Exploring the utility of cellular indices in the diagnosis of ulcerative colitis
Julio César Moreno Alfonso, Sharom Barbosa-Velásquez, Carlos Delgado-Miguel, Ada Molina Caballero, Sara Hernández-Martín, Alberto Pérez Martínez, María Concepción Yárnoz Irazábal
Gastroenterología y Hepatología.2025; : 502349. CrossRef
Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease
Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park
Intestinal Research.2024; 22(1): 75. CrossRef
Evaluation of the prognostic nutritional index (PNI) as a tool for assessing disease activity in rheumatoid arthritis patients
Nuran Öz, Halise Hande Gezer, Selin Cilli Hayıroğlu, Mehmet Tuncay Duruöz
Clinical Rheumatology.2024; 43(5): 1461. CrossRef
Progress in Biomarkers of Inflammatory Bowel Disease
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Advances in Clinical Medicine.2024; 14(03): 1418. CrossRef
Fecal calprotectin and platelet count predict histologic disease activity in pediatric ulcerative colitis: results from a projection-predictive feature selection
B. Schiller, E. Wirthgen, F. Weber, S. Schiller, M. Radke, M. Claßen, J. Däbritz, S. Buderus, P. Bufler, J. Däbritz, S. Dammann, J. de Laffolie, M. Friedt, A. Hauer, K. M. Keller, A. Krahl, M. Laaß, T. Lang, C. Posovszky, B. Rodeck, S. Trenkel
European Journal of Pediatrics.2024; 183(8): 3277. CrossRef
Association of Hemogram Parameters with Body Mass Index in Knee Osteoarthritis
Koksal Gundogdu, Gülşah Gündoğdu, Alper Kurtoğlu
Online Türk Sağlık Bilimleri Dergisi.2024; 9(3): 202. CrossRef
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Anas Elgenidy, Omar Alomari, Tasbih Emad, Sara K. Kamal, Islam E. Al Ghanam, Aya Sherif, Mohammed Al-mahdi Al-kurdi, Abdallah A. Helal, Yusof Mohamed Omar, Mohamed Rafiek Ramadan
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CRP/Albumin Ratio as Potential Indicator for Assessment of Disease Activity in Inflammatory Bowel Disease Patients
Fatma Abdel-Kader Attia Mohamed, Eman Refaat Youness, Marwa M. Hassan, Nesma Hassan Hasanein Ashour
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LN Altunal, AS Ozel, C AK
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Arefeh Zahmatkesh, Mohammad Hassan Sohouli, Seyed Mahmoud Eshagh Hosseini, Pejman Rohani
European Journal of Pediatrics.2023; 182(9): 4263. CrossRef
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İlyas TENLİK, Orhan COŞKUN, Mustafa ÇAPRAZ, Volkan GÖKBULUT, Ömer ÖZTÜRK
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Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy
Danny Con, Bridgette Andrew, Steven Nicolaides, Daniel R van Langenberg, Abhinav Vasudevan
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BMC Gastroenterology.2020;[Epub] CrossRef

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Review

IBD

Does fecal calprotectin equally and accurately measure disease activity in small bowel and large bowel Crohn’s disease?: a systematic review: Ebby George Simon, Richard Wardle, Aye Aye Thi, Jeanette Eldridge, Sunil Samuel, Gordon William Moran; Intest Res 2019;17(2):160-170. Published online February 7, 2019; DOI: https://doi.org/10.5217/ir.2018.00114

Abstract PDF Supplementary Material PubReader ePub

Fecal calprotectin (FC) is a highly sensitive disease activity biomarker in inflammatory bowel disease. However, there are conflicting reports on whether the diagnostic accuracy in Crohn’s disease is influenced by disease location. The aim of this study was to undertake a systematic review of the published literature. Relevant databases were searched from inception to November 8, 2016 for cohort and case control studies which had data on FC in patients with isolated small bowel (SB) and large bowel (LB) Crohn’s disease. Reference standards for disease activity were endoscopy, magnetic resonance imaging, computed tomography or a combination of these. The QUADAS-2 research tool was used to assess the risk of bias. There were 5,619 records identified at initial search. The 2,098 duplicates were removed and 3,521 records screened. Sixty-one full text articles were assessed for eligibility and 16 studies were included in the final review with sensitivities and specificities per disease location available from 8 studies. Sensitivities of FC at SB and LB locations ranged from 42.9% to 100% and 66.7% to 100% respectively while corresponding specificities were 50% to 100% and 28.6% to 100% respectively. The sensitivities and specificities of FC to accurately measure disease activity in Crohn’s disease at different disease locations are diverse and no firm conclusion can be made. Better studies need to be undertaken to categorically answer the effect of disease location on the diagnostic accuracy of FC.

Citations

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Unravelling metabolite-microbiome interactions in inflammatory bowel disease through AI and interaction-based modelling
Rebecca Hodgkiss, Animesh Acharjee
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Development of a capsule endoscopy scoring system for the early diagnosis of small bowel Crohn’s disease
Yuya Ogino, Kento Sadashima, Yuichiro Yoshida, Hironobu Takedomi, Nanae Tsuruoka, Yasuhisa Sakata, Ayako Takamori, Tadakazu Hisamatsu, Takayuki Matsumoto, Motohiro Esaki
Journal of Gastroenterology.2025;[Epub] CrossRef
Leucine-rich alpha-2 glycoprotein is useful in predicting clinical relapse in patients with Crohn’s disease during biological remission
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Intestinal Research.2025; 23(2): 170. CrossRef
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European Journal of Clinical Nutrition.2024; 78(1): 48. CrossRef
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Jihye Park
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International Journal of Molecular Sciences.2024; 25(6): 3167. CrossRef
Circulatory resistin levels in inflammatory bowel disease: a systematic review and meta-analysis
Amir Hossein Behnoush, Seyede Parmis Maroufi, Tara Reshadmanesh, Yasmin Mohtasham Kia, Mitra Norouzi, Seyedeh Mina Mohammadi, Aleksandra Klisic, Amirmohammad Khalaji
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Original Articles

IBD

The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces: Sakiko Hiraoka, Shiho Takashima, Toshihiro Inokuchi, Asuka Nakarai, Masahiro Takahara, Keita Harada, Yasuhiro Seki, Katsunori Watanabe, Jun Kato, Hiroyuki Okada; Intest Res 2019;17(2):202-209. Published online December 14, 2018; DOI: https://doi.org/10.5217/ir.2018.00086

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system.
Methods
Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification.
Results
The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively.
Conclusions
The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC.

Citations

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Systematic scoping review: Use of the faecal immunochemical test residual buffer to enhance colorectal cancer screening
Timothy McAuliffe, Joseph C. Anderson, Robin J. Larson, Douglas J. Robertson
Alimentary Pharmacology & Therapeutics.2024; 59(9): 1033. CrossRef
Evaluation of a faecal calprotectin method using the OC-SENSOR PLEDIA
Shane O’Driscoll, Carolyn Piggott, Sally C. Benton
Clinical Chemistry and Laboratory Medicine (CCLM).2022; 60(6): 901. CrossRef
International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases
Ferdinando D'Amico, David T. Rubin, Paulo Gustavo Kotze, Fernando Magro, Britta Siegmund, Taku Kobayashi, Pablo A. Olivera, Peter Bossuyt, Lieven Pouillon, Edouard Louis, Eugeni Domènech, Subrata Ghosh, Silvio Danese, Laurent Peyrin‐Biroulet
United European Gastroenterology Journal.2021; 9(4): 451. CrossRef
Faecal Calprotectin in Assessment of Mucosal Healing in Adults with Inflammatory Bowel Disease: A Meta-Analysis
Mariusz A. Bromke, Katarzyna Neubauer, Radosław Kempiński, Małgorzata Krzystek-Korpacka
Journal of Clinical Medicine.2021; 10(10): 2203. CrossRef
Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease
Eriko Yasutomi, Toshihiro Inokuchi, Sakiko Hiraoka, Kensuke Takei, Shoko Igawa, Shumpei Yamamoto, Masayasu Ohmori, Shohei Oka, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Keita Harada, Masaki Furukawa, Kouichi Itoshima, Ken Okada, Fumio Otsuka,
Scientific Reports.2021;[Epub] CrossRef
Optimal Cutoff Level of Fecal Calprotectin for Detecting Small Bowel Inflammation in Crohn's Disease
Eun Soo Kim
Gut and Liver.2021; 15(5): 637. CrossRef
Fecal calprotectin predicts complete mucosal healing in patients with ulcerative colitis: Systematic review and meta‑analysis
Zhongsheng Cao, Chenglong Ye, Lunan Li, Xiaoge Geng, Wensheng Pan, Jiyong Jing
World Academy of Sciences Journal.2021;[Epub] CrossRef
Biochemical Biomarkers of Mucosal Healing for Inflammatory Bowel Disease in Adults
Małgorzata Krzystek-Korpacka, Radosław Kempiński, Mariusz Bromke, Katarzyna Neubauer
Diagnostics.2020; 10(6): 367. CrossRef
Prostaglandin E-Major Urinary Metabolite Predicts Relapse in Patients With Ulcerative Colitis in Clinical Remission
Natsuki Ishida, Kiichi Sugiura, Takahiro Miyazu, Satoshi Tamura, Satoshi Suzuki, Shinya Tani, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Satoshi Osawa, Takahisa Furuta, Ken Sugimoto
Clinical and Translational Gastroenterology.2020; 11(12): e00289. CrossRef
Prediction of treatment outcome and relapse in inflammatory bowel disease
Jun Kato, Takeichi Yoshida, Sakiko Hiraoka
Expert Review of Clinical Immunology.2019; 15(6): 667. CrossRef

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IBD

Experience of patients with inflammatory bowel disease in using a home fecal calprotectin test as an objective reported outcome for self-monitoring: Shu-Chen Wei, Chien-Chih Tung, Meng-Tzu Weng, Jau-Min Wong; Intest Res 2018;16(4):546-553. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00052

Abstract PDF PubReader ePub

Background/Aims
Fecal calprotectin (fC) level is a predictive marker of mucosal healing for patients with inflammatory bowel disease (IBD). Home fC tests are now available. We evaluated the performance of the smartphone-based IBDoc home testing system in patients with IBD and obtained their feedback as an objective patient-reported outcome.
Methods
This prospective study enrolled consecutive patients with IBD in clinical remission. fC in the same stool sample was assessed by using both the laboratory test (Quantum Blue calprotectin test) and home test (IBDoc). The correlation between the 2 tests was analyzed using the Pearson method. In addition, the patients were asked to fill a questionnaire based on their experience.
Results
Fifty-one patients with IBD (68 tests and 49 questionnaires) were included. The correlation between Quantum Blue test and IBDoc was good (r=0.776, P<0.0001). After the test, 56% patients found IBDoc easy to perform, and 96% were satisfied with it. Thirty-nine patients (80%) had a strong (>70%) probability to use it for future monitoring if the price was acceptable. By using 250 μg/g as the cutoff, the agreement between home test and laboratory results was 80%, and by using 600 μg/g as the cutoff, the agreement increased to 92%.
Conclusions
The correlation between the laboratory and home tests was good. Most patients found the home test to be feasible and easy to use and preferred it over laboratory test and endoscopy for monitoring. Therefore, the home test could be used as an objective patient-reported outcome.

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Aditi Kumar, Kohi Gananandan, Guy Robinson, Jennie Clough, Oliver D Tavabie
Frontline Gastroenterology.2025; : flgastro-2024-102997. CrossRef
Validation of rapid fecal calprotectin assay using particle enhanced turbidimetric immunoassay for inflammatory bowel disease
Akihiko Oka, Kousaku Kawashima, Kenichi Kishimoto, Satoshi Kotani, Mai Fukunaga, Nobuhiko Fukuba, Yoshiyuki Mishima, Naoki Oshima, Norihisa Ishimura, Muyiwa Awoniyi, Shunji Ishihara
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iSTART-II: An Update on the i Support Therapy–Access to Rapid Treatment (iSTART) Approach for Patient-Centered Therapy in Mild-to-Moderate Ulcerative Colitis
Ferdinando D’Amico, Fernando Magro, Benedicte Caron, Axel Dignass, Vipul Jairath, Ailsa Hart, Paulo Gustavo Kotze, Kristine Paridaens, Sameer Al Awadhi, Taku Kobayashi, Britta Siegmund, Laurent Peyrin-Biroulet, Silvio Danese
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Rune Wilkens, Michael Dolinger, Johan Burisch, Christian Maaser
Gastroenterology.2022; 162(5): 1476. CrossRef
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Richard Y. Wu, Parul Tandon, Lindsy Ambrosio, Garett Dunsmore, Naomi Hotte, Levinus A. Dieleman, Shokrollah Elahi, Karen Madsen, Vivian Huang
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Dandan Liu, Varma Saikam, Katie A. Skrada, Didier Merlin, Suri S. Iyer
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Richard Y. Wu, Karren Xiao, Naomi Hotte, Parul Tandon, Yesmine Elloumi, Lindsy Ambrosio, Garett Dunsmore, Shokrollah Elahi, Karen I. Kroeker, Levinus A. Dieleman, Karen L. Madsen, Vivian Huang
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Self-monitoring with home based fecal calprotectin is associated with increased medical treatment. A randomized controlled trial on patients with inflammatory bowel disease
Isak Östlund, Mårten Werner, Pontus Karling
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Júlio Maria Fonseca Chebli, Natália Sousa Freitas Queiroz, Adérson Omar Mourão Cintra Damião, Liliana Andrade Chebli, Márcia Henriques de Magalhães Costa, Rogério Serafim Parra
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Ferdinando D'Amico, David T. Rubin, Paulo Gustavo Kotze, Fernando Magro, Britta Siegmund, Taku Kobayashi, Pablo A. Olivera, Peter Bossuyt, Lieven Pouillon, Edouard Louis, Eugeni Domènech, Subrata Ghosh, Silvio Danese, Laurent Peyrin‐Biroulet
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A Patient Self-Made Point-of-Care Fecal Test Improves Diagnostic Accuracy Compared with Fecal Calprotectin Alone in Inflammatory Bowel Disease Patients
Gonzalo Hijos-Mallada, Raul Velamazán, Raúl Marti, Eduardo Chueca, Samantha Arechavaleta, Alberto Lué, Fernando Gomollón, Angel Lanas, Carlos Sostres
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European Journal of Gastroenterology & Hepatology.2021; 33(1S): e777. CrossRef
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Jongbeom Shin, Sung Min Kong, Gyeol Seong, Young-Ho Kim
International Journal of Colorectal Disease.2020; 35(12): 2249. CrossRef
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K Malíčková, V Pešinová, M Kolář, M Lukáš
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Home-based fecal calprotectin test is expected to play an important role in patients with inflammatory bowel diseases
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IBD

Usefulness of fecal calprotectin by monoclonal antibody testing in adult Japanese with inflammatory bowel diseases: a prospective multicenter study: Shiro Nakamura, Hirotsugu Imaeda, Hiroki Nishikawa, Masaki Iimuro, Minoru Matsuura, Hideo Oka, Junsuke Oku, Takako Miyazaki, Hirohito Honda, Kenji Watanabe, Hiroshi Nakase, Akira Andoh; Intest Res 2018;16(4):554-562. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00027

Abstract PDF PubReader ePub

Background/Aims
Noninvasive objective monitoring is advantageous for optimizing treatment strategies in patients inflammatory bowel disease (IBD). Fecal calprotectin (FCP) is superior to traditional biomarkers in terms of assessing the activity in patients with IBD. However, there are the differences among several FCP assays in the dynamics of FCP. In this prospective multicenter trial, we investigated the usefulness of fecal FCP measurements in adult Japanese patients with IBD by reliable enzyme immunoassay using a monoclonal antibody.
Methods
We assessed the relationship between FCP levels and disease or endoscopic activity in patients with ulcerative colitis (UC, n=64) or Crohn’s disease (CD, n=46) compared with healthy controls (HCs, n=64).
Results
FCP levels in UC patients strongly correlated with the Disease Activity Index (rs=0.676, P<0.0001) and Mayo endoscopic subscore (MES; rs=0.677, P<0.0001). FCP levels were significantly higher even in patients with inactive UC or CD compared with HCs (P=0.0068, P<0.0001). The optimal cutoff value between MES 1 and 2 exhibited higher sensitivity (94.1%). FCP levels were significantly higher in active UC patients than in inactive patients (P<0.001), except those with proctitis. The Crohn’s Disease Activity Index tended to correlate with the FCP level (rs=0.283, P=0.0565).
Conclusions
Our testing method using a monoclonal antibody for FCP was well-validated and differentiated IBD patients from HCs. FCP may be a useful biomarker for objective assessment of disease activity in adult Japanese IBD patients, especially those with UC.

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Tomohiro Fukuda, Makoto Naganuma, Kaoru Takabayashi, Yuya Hagihara, Shun Tanemoto, Ena Nomura, Yusuke Yoshimatsu, Shinya Sugimoto, Kosaku Nanki, Shinta Mizuno, Yohei Mikami, Kayoko Fukuhara, Tomohisa Sujino, Makoto Mutaguchi, Nagamu Inoue, Haruhiko Ogata,
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Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion
Kenji Watanabe
Intestinal Research.2020; 18(4): 347. CrossRef

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IBD

Usefulness of fecal immunochemical test and fecal calprotectin for detection of active ulcerative colitis: Dong Ju Kim, Yoon Mi Jeoun, Dong-won Lee, Ja Seol Koo, Sang Woo Lee; Intest Res 2018;16(4):563-570. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00020

Abstract PDF PubReader ePub

Background/Aims
Ulcerative colitis undergoes periods of exacerbation and remission. Fecal calprotectin levels increase with gut inflammation and correlate with endoscopic disease activity in ulcerative colitis. Intestinal blood loss and fecal immunochemical test levels also correlate with endoscopic disease activity. This study statistically evaluated the usefulness of fecal calprotectin, fecal immunochemical test, and C-reactive protein (CRP) as markers of disease activity.
Methods
A total 106 ulcerative colitis patients who underwent endoscopy and fecal calprotectin, fecal immunochemical test, and CRP testing, from March 2015 to August 2016, were retrospectively reviewed. Disease activity was assessed using a partial Mayo score and Mayo endoscopic score. The ability of fecal and serologic tests to reflect endoscopic disease severity was statistically evaluated.
Results
Among 106 patients, 68 underwent endoscopy and stool study within 2 weeks. In patients with mild to severe activity, fecal immunochemical test and fecal calprotectin were superior to CRP at Mayo endoscopic score detection rate. The area under the curves of fecal immunochemical test and fecal calprotectin for the detection of Mayo endoscopic score ≥1 were 0.956 and 0.942, respectively, and were superior to that of CRP (0.756). At Mayo endoscopic score, the effects of combination of fecal immunochemical test and CRP or fecal calprotectin and CRP were found to be higher than those of the independent fecal immunochemical test or fecal calprotectin.
Conclusions
Fecal immunochemical test and fecal calprotectin can effectively detect active ulcerative colitis better than remission. As these markers reflect the status of mucosal inflammation, they may reduce the requirement for invasive endoscopic examination.

Citations

Citations to this article as recorded by

Histologic features and predicting prognosis in ulcerative colitis patients with mild endoscopic activity
Seung Yong Shin, Hee Sung Kim, Kisung Kim, Chang Won Choi, Jung Min Moon, Jeong Wook Kim, Hyun Jin Joo, Jeongkuk Seo, Muhyeon Sung, Chang Hwan Choi
The Korean Journal of Internal Medicine.2024; 39(1): 68. CrossRef
Prostaglandin E‐major urinary metabolite diagnoses mucosal healing in patients with ulcerative colitis in remission phase
Toshiyuki Sakurai, Yoshihiro Akita, Haruna Miyashita, Ryosuke Miyazaki, Yuki Maruyama, Tomoko Saito, Mariko Shimada, Takuji Yamasaki, Seiji Arhihiro, Tomohiro Kato, Tomokazu Matsuura, Masahiro Ikegami, Isao Okayasu, Masayuki Saruta
Journal of Gastroenterology and Hepatology.2022; 37(5): 847. CrossRef
Alternative diagnoses and demographics associated with a raised quantitative faecal immunochemical test in symptomatic patients
Mark S Johnstone, Gillian Miller, Grace Pang, Paul Burton, Georgios Kourounis, Jack Winter, Emilia Crighton, David Mansouri, Paul Witherspoon, Karen Smith, Stephen T McSorley
Annals of Clinical Biochemistry: International Journal of Laboratory Medicine.2022; 59(4): 277. CrossRef
Correlation of fecal calprotectin and patient-reported outcome measures in patients with ulcerative colitis
Nagesh Kamat, Sudheer K Vuyyuru, Saurabh Kedia, Pabitra Sahu, Bhaskar Kante, Peeyush Kumar, Mukesh Kumar Ranjan, Mukesh Kumar Singh, Sambuddha Kumar, Vikas Sachdev, Govind Makharia, Vineet Ahuja
Intestinal Research.2022; 20(2): 269. CrossRef
Determining the usefulness of Capsule Scoring of Ulcerative Colitis in predicting relapse of inactive ulcerative colitis
Mao Matsubayashi, Taku Kobayashi, Shinji Okabayashi, Masaru Nakano, Shintaro Sagami, Ryo Ozaki, Hiroki Kiyohara, Hiromu Morikubo, Kunio Asonuma, Yusuke Miyatani, Shin Maeda, Toshifumi Hibi
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Gabriele Dragoni, Tommaso Innocenti, Andrea Galli
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Jack S. Cornish, Elisa Wirthgen, Jan Däbritz
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Hsu-Heng Yen, Mei-Wen Chen, Yu-Yao Chang, Hsuan-Yuan Huang, Tsui-Chun Hsu, Yang-Yuan Chen
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What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?
Jongbeom Shin, Sung Min Kong, Gyeol Seong, Young-Ho Kim
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Prostaglandin E-Major Urinary Metabolite Predicts Relapse in Patients With Ulcerative Colitis in Clinical Remission
Natsuki Ishida, Kiichi Sugiura, Takahiro Miyazu, Satoshi Tamura, Satoshi Suzuki, Shinya Tani, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Satoshi Osawa, Takahisa Furuta, Ken Sugimoto
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Parambir S. Dulai, Laurent Peyrin-Biroulet, Silvio Danese, Bruce E. Sands, Axel Dignass, Dan Turner, Gerassimos Mantzaris, Juergen Schölmerich, Jean-Yves Mary, Walter Reinisch, William J. Sandborn
Gastroenterology.2019; 157(4): 1032. CrossRef

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Accuracy of three different fecal calprotectin tests in the diagnosis of inflammatory bowel disease: Hui Won Jang, Hyun Sook Kim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon; Intest Res 2016;14(4):305-313. Published online October 17, 2016; DOI: https://doi.org/10.5217/ir.2016.14.4.305

Abstract PDF PubReader

<b>Background/Aims</b><br/>

Several studies have found that the measurement of fecal calprotectin is useful for the early diagnosis of inflammatory bowel disease (IBD). We compared the effectiveness of three different fecal calprotectin kits for initial diagnosis in patients with suspected IBD.

Methods

We enrolled 31 patients with IBD (18 Crohn's disease [CD], 11 ulcerative colitis [UC], and two intestinal Behçet's disease), five with irritable bowel syndrome (IBS), and five with other colitis (four infectious colitis and one intestinal tuberculosis). Diagnosis was based on clinical, laboratory, and endoscopic examinations. Fecal samples were obtained at the first diagnosis and calprotectin levels were measured using three different kits (Quantum Blue® Calprotectin, EliA™ Calprotectin, and RIDASCREEN® Calprotectin).

Results

The overall accuracy for differentiating IBD from IBS or other colitis was 94% and 91%, respectively, for Quantum Blue® (cutoff, 50 µg/g); 92% and 89%, respectively, for EliA™ (cutoff, 50 µg/g); and 82% and 76%, respectively, for RIDASCREEN® (cutoff, 50 µg/g). In patients with CD, the results of Quantum Blue® Calprotectin and EliA™ Calprotectin correlated significantly with levels of the Crohn's disease activity index (Spearman's rank correlation coefficient, r=0.66 and r=0.49, respectively). In patients with UC, the results of EliA™ Calprotectin correlated significantly with the Mayo score (r=0.70).

Conclusions

Fecal calprotectin measurement is useful for the identification of IBD. The overall accuracies of the three fecal calprotectin kits are comparable.

Citations

Citations to this article as recorded by

Network pharmacology analysis and animal experiment validation of inflammation inhibition by Swertiamarin in treating Ulcerative colitis
Tang Jiafeng, Wang Lijuan, Wei Lan, You Yiqing, Yang Shiyu, Zeng Tao, Dang Tingting, Sun Haoli, Li Xiaoshan, Zhang Yan
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Values of serum intestinal fatty acid-binding protein, fecal calprotectin, and fecal human β-defensin 2 for predicting necrotizing enterocolitis
Sujia Liu, Yongle Liu, Shuhua Lai, Yingling Xie, Wenlong Xiu, Changyi Yang
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M.S. Ismail, Serhiy Semenov, Deirdre McNamara
Current Opinion in Gastroenterology.2021; 37(3): 284. CrossRef
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Jong-Mi Lee, Joo Hee Jang, Ji Hyeong Ryu, Jaeeun Yoo, Bo-In Lee, Seung-Jun Kim, Eun-Jee Oh, Hsu-Heng Yen
PLOS ONE.2021; 16(8): e0255974. CrossRef
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Geert D’Haens, Orlaith Kelly, Robert Battat, Mark S. Silverberg, David Laharie, Edouard Louis, Edoardo Savarino, Giorgia Bodini, Andres Yarur, Brigid S. Boland, Waqqas Afif, Xiao-jun Li, Michael Hale, Jessica Ho, Venkateswarlu Kondragunta, Benjamin Huang,
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Emilio J. Laserna-Mendieta, Alfredo J. Lucendo
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Christopher Ma, Robert Battat, Claire E. Parker, Reena Khanna, Vipul Jairath, Brian Gordon Feagan
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Serum Adipocytokine Levels as Surrogate Markers for Disease Activity of Crohn’s Disease
Su Hwan Kim, Seung Hyeon Jang, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, You Sun Kim, Dong Soo Han, Joo Sung Kim
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Could fecal calprotectin enter mainstream use for diagnosing and monitoring inflammatory bowel disease?
Shu Chen Wei
Intestinal Research.2016; 14(4): 293. CrossRef

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Review

Fecal immunochemical test as a biomarker for inflammatory bowel diseases: can it rival fecal calprotectin?: Jun Kato, Sakiko Hiraoka, Asuka Nakarai, Shiho Takashima, Toshihiro Inokuchi, Masao Ichinose; Intest Res 2016;14(1):5-14. Published online January 25, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.5

Abstract PDF PubReader ePub

Accurate evaluation of disease activity is essential for choosing an appropriate treatment and follow-up plan for patients with inflammatory bowel disease (IBD). Endoscopy is required for accurately evaluating disease activity, but the procedures are sometimes invasive and burdensome to patients. Therefore, alternative non-invasive methods for evaluating or predicting disease activity including mucosal status are desirable. Fecal calprotectin (Fcal) is the most widely used fecal marker for IBD, and many articles have described the performance of the marker in predicting disease activity, mucosal healing (MH), treatment efficacy, and risk of relapse. Fecal immunochemical test (FIT) can quantify the concentration of hemoglobin in stool and was originally used for the screening of colorectal cancer. We recently reported that FIT is also a useful biomarker for IBD. A direct comparison between the use of Fcal and FIT showed that both methods predicted MH in ulcerative colitis equally well. However, in the case of Crohn's disease, FIT was less sensitive to lesions in the small intestine, compared to Fcal. FIT holds several advantages over Fcal in regards to user-friendliness, including a lower cost, easy and clean handling, and the ability to make rapid measurements by using an automated measurement system. However, there is insufficient data to support the application of FIT in IBD. Further studies into the use of FIT for evaluating the inflammatory status of IBD are warranted.

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