Fecal calprotectin as an index of intestinal inflammation

The assessment of inflammatory activity in intestinal disease in man can be done using a variety of different techniques, from measurement of conventi onal noninvasive acute-phase inflammatory markers in plasma (C-reactive pro tein and the erythrocyte sedimentation rate) to the direct assessment of di sease activity by intestinal biopsy. However, most of these techniques have significant limitations when it comes to assessing functional components o f the disease that relate to activity and prognosis. Here we briefly review the value of a novel emerging intestinal function test, fecal calprotectin . Single stool assay of neutrophil-specific proteins (calprotectin, lactofe rrin) give the same quantitative data on intestinal inflammation as the 4-d ay fecal excretion of indium-111-labeled white cells. Elevated levels of fe cal calprotectin have been demonstrated in patients with NSAID-induced ente ropathy and have been used in the diagnosis of colorectal cancer. Fecal cal protectin is increased in over 95% of patients with inflammatory bowel dise ase (IBD) and correlates with clinical disease activity. It reliably differ entiates between patients with IBD and irritable bowel syndrome (IBS). More importantly, at a given fecal calprotectin concentration in patients with quiescent IBD, the test has a specificity and sensitivity in excess of 85% in predicting clinical relapse of disease. This suggests that relapse of IB D is closely related to the degree of intestinal inflammation and suggests that targeted treatment at an asymptomatic stage of the disease may be indi cated. (C) 2001 Prous Science. All rights reserved.