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Kawamoto A, Takenaka K, Hibiya S, Kitazume Y, Shimizu H, Fujii T, Saito E, Ohtsuka K, Okamoto R. Combination of leucine-rich alpha-2 glycoprotein and fecal markers detect Crohn's disease activity confirmed by balloon-assisted enteroscopy. Intest Res 2024; 22:65-74. [PMID: 37939721 PMCID: PMC10850704 DOI: 10.5217/ir.2023.00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic activity confirmed by enteroscopy is associated with poor clinical outcome in Crohn's disease (CD). We investigated which of the existing biomarkers best reflects endoscopic activity in CD patients including the small bowel, and whether their combined use can improve accuracy. METHODS One hundred and four consecutive patients with ileal and ileocolonic type CD who underwent balloon-assisted enteroscopy (BAE) from October 2021 to August 2022 were enrolled, with clinical and laboratory data prospectively collected and analyzed. RESULTS Hemoglobin, platelet count, C-reactive protein, leucine-rich alpha-2 glycoprotein (LRG), fecal calprotectin, and fecal hemoglobin all showed significant difference in those with ulcers found on BAE. LRG and fecal calprotectin showed the highest areas under the curve (0.841 and 0.853) for detecting ulcers. LRG showed a sensitivity of 78% and specificity of 80% at a cutoff value of 13 μg/mL, whereas fecal calprotectin showed a sensitivity of 91% and specificity of 67% at a cutoff value of 151 μg/g. Dual positivity for LRG and fecal calprotectin, as well as LRG and fecal hemoglobin, both predicted ulcers with an improved specificity of 92% and 100%. A positive LRG or fecal calprotectin/hemoglobin showed an improved sensitivity of 96% and 91%. Positivity for LRG and either of the fecal biomarkers was associated with increased risk of hospitalization, surgery, and relapse. CONCLUSIONS The biomarkers LRG, fecal calprotectin, and fecal hemoglobin can serve as noninvasive and accurate tools for assessing activity in CD patients confirmed by BAE, especially when used in combination.
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Affiliation(s)
- Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Endoscopic Unit, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuji Hibiya
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Endoscopic Unit, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshio Kitazume
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiromichi Shimizu
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiko Saito
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Endoscopic Unit, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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Castellano MA, Scheeffer V, Petersen V, da Silveira TR. Evaluation of bowel wall flow by color Doppler ultrasound in the assessment of inflammatory bowel disease activity in pediatric patients. Radiol Bras 2023; 56:242-247. [PMID: 38204905 PMCID: PMC10775812 DOI: 10.1590/0100-3984.2023.0039-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/29/2023] [Accepted: 07/27/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To assess inflammatory bowel disease (IBD) activity with Doppler ultrasound in pediatric patients, comparing the accuracy of the ultrasound findings with that of the concentrations of fecal calprotectin (FC). Materials and Methods In a consecutive series, we evaluated 53 examinations of 44 pediatric patients seen between 2014 and 2020: 28 with Crohn's disease, 15 with ulcerative colitis, and one with IBD unclassified. The diagnosis of IBD was made in accordance with the Porto criteria. The alteration studied in the greatest detail was bowel wall flow, which was classified by the lead investigator and two pediatric radiologists, all of whom were blinded to the FC concentrations and the other ultrasound findings. Bowel wall flow was categorized as low if there were up to 2 Doppler ultrasound signals/cm2, moderate if there were 3-5 signals/cm2, and high if there were more than 5 signals/cm2. Results The agreement among the radiologists was substantial (kappa = 0.73). In cases in which ultrasound showed low bowel wall flow, the median FC concentration was 92 µg/g (interquartile range, 33-661 µg/g), whereas it was 2,286 µg/g (interquartile range, 1,728-5,612 µg/g) in those in which ultrasound showed high bowel wall flow. In the sample as a whole, the sensitivity and specificity of ultrasound was 89.7% and 92.0%, respectively, for the detection of inflammatory activity; 95.5% and 90.9%, respectively, for the detection of Crohn's disease; and 81.3% and 100.0%, respectively, for the detection of ulcerative colitis. Conclusion Ultrasound of the bowel wall showed a strong correlation with FC concentrations in the assessment of inflammatory activity in pediatric patients with IBD.
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Affiliation(s)
- Marco Aurélio Castellano
- Hospital da Criança Santo Antônio da Santa Casa de
Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Vanessa Scheeffer
- Hospital da Criança Santo Antônio da Santa Casa de
Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Vanessa Petersen
- Hospital da Criança Santo Antônio da Santa Casa de
Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Abstract
BACKGROUND Obesity is a complex, medical condition causally contributing to many chronic diseases and a number of efforts have been made to find the associated markers for novel prevention and treatment of obesity. Our study was to evaluate the relationship between gut immune response and obesity and overweight with use of fecal calprotectin (FC) both in adult and children groups. METHODS Fecal samples were obtained from 74 subjects: 14 non-obese and overweight children (PN), 13 obese and overweight children (PO), 20 non-obese and overweight adults (AN), and 27 obese and overweight adults (AO). FC was measured using a commercial Legend Max quantitative enzyme-linked immunosorbent assay (BioLegend). Mann-Whitney U-test was used for statistical analysis. RESULTS Median FC concentration was 7.9 μg/g (range, 1.9-28.9 μg/g) for PN, 5.0 μg/g (range, 2.6-29.6 μg/g) for PO, 9.5 μg/g (range, 0.8-28.9 μg/g) for AN, and 10.0 μg/g (range, 1.6-25.6 μg/g) for AO, respectively. In both adults and children age groups, the FC showed no statistically significant difference between AO and AN or PO and PN. However, FC showed statistically significant difference (P<0.05) between AO and PO while not significant between AN and PN. CONCLUSION FC level in AO was significantly higher than that in PO, suggestive of different pathophysiologic mechanism between children obesity and adults obesity.
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Affiliation(s)
- Shin Young Park
- Department of Clinical Pathology, Cheju Halla University, Jeju,
Korea
| | - Woo Jin Kim
- Department of Laboratory Medicine, Cheju Halla General Hospital, Jeju,
Korea
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Nordal HH, Fagerhol MK, Halse AK, Hammer HB. Calprotectin (S100A8/A9) should preferably be measured in EDTA-plasma; results from a longitudinal study of patients with rheumatoid arthritis. Scand J Clin Lab Invest 2017; 78:102-108. [PMID: 29278951 DOI: 10.1080/00365513.2017.1419371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Calprotectin (S100A8/A9), a protein expressed in neutrophils and monocytes/macrophages in circulation and inflamed tissue, is associated with measures of disease activity in rheumatoid arthritis (RA) patients both when measured in ethylenediaminetetraacetic acid (EDTA)-plasma and in serum. We wanted to explore if EDTA-plasma or serum should be preferred for calprotectin as a marker of disease activity. Calprotectin was analysed in EDTA-plasma and serum by enzyme-linked immunosorbent assay (ELISA) at baseline in 141 RA patients, starting biologic disease-modifying anti-rheumatic drugs (bDMARDs), and after three months. Differences between plasma and serum levels of calprotectin were assessed by Wilcoxon signed rank test. Variability was assessed by quartile coefficient of dispersion. Spearman's test explored correlations between calprotectin in plasma and serum and between calprotectin (plasma or serum) and clinical/ultrasound (US) measures of disease activity. Bland Altman plots were used for method comparisons. Conventional inflammatory markers were evaluated for comparison. Calprotectin had similar variability when measured in plasma and serum, but there was a significant difference in concentrations between plasma and serum (p < .001). The correlation coefficients at baseline between calprotectin measured in plasma/serum and measures of disease activity were rs = 0.62/0.46 for sum power Doppler score (PD), rs = 0.60/0.48 for assessor's global visual analogue scale (VAS), rs = 0.59/0.43 for sum grey scale (GS) score and rs = 0.47/0.37 for swollen joint count of 32, all p < .001. Similar differences were found after three months. Calprotectin measured in plasma showed the strongest associations with assessments of disease activity, and EDTA-plasma should preferably be used when evaluating disease activity in RA patients.
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Affiliation(s)
- Hilde Haugedal Nordal
- a Broegelmann Research Laboratory, Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Rheumatology , Haukeland University Hospital , Bergen , Norway
| | | | - Anne-Kristine Halse
- b Department of Rheumatology , Haukeland University Hospital , Bergen , Norway.,d Department of Clinical Science , University of Bergen , Bergen , Norway
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Garg M, Leach ST, Day AS, Ooi CY. Fecal calprotectin concentrations in young children with cystic fibrosis: Authors response. J Cyst Fibros 2017; 17:e10-e11. [PMID: 29128316 DOI: 10.1016/j.jcf.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Millie Garg
- School of Women's and Children's Health, Medicine, The University of New South Wales, High Street, Randwick 2031, New South Wales, Australia.
| | - Steven T Leach
- School of Women's and Children's Health, Medicine, The University of New South Wales, High Street, Randwick 2031, New South Wales, Australia
| | - Andrew S Day
- Department of Pediatrics, University of Otago, Riccarton Ave, Christchurch 8011, Canterbury, New Zealand
| | - Chee Y Ooi
- School of Women's and Children's Health, Medicine, The University of New South Wales, High Street, Randwick 2031, New South Wales, Australia; miCF Research Centre and Department of Gastroenterology, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia.
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Abstract
Objective: To investigate the application value of serum calprotectin in assessing the activity of IBD Methods: Eighty-five Crohn's disease(CD) and eighty-five Ulcerative colitis(UC) patients at Suzhou Municipal Hospital(North Branch) from August 2015 to January 2017 were enrolled in this study, and eighty-five healthy subjects were selected as controls. Serum level of calprotectin was determined by ELISA. Correlation of serum calprotectin with clinical features of IBD was analyzed. The diagnostic efficacy for CD and UC were assessed by ROC curve. Results: The level of serum calprotectin was significantly higher in IBD patients than in healthy subjects. Positive correlations were found between serum calprotectin level and CRP, ESR, fecal calprotectin level of IBD(ρ=0.341, P<0.001;ρ=0.438, P<0.001;ρ=0.542, P<0.001,respectively). Besides, positive correlations were found between serum calprotectin level with disease activity index(CDAI or Mayo score) of IBD(ρ=0.309, P=0.004;ρ=0.227, P=0.036,respectively).Nevertheless, no correlation was found between serum calprotectin level with location of IBD and disease subtypes(P>0.05).The area under curve(AUC) of serum calprotectin for diagnosis of CD and UC were 0.946 and 0.906, respectively. Conclusions: Serum level of calprotectin is associated with the activity of IBD. As a result,serum level of calprotectin may has the potential to be served as a clinical index of IBD activity.
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Affiliation(s)
| | | | - Z Pang
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Garg M, Leach ST, Coffey MJ, Katz T, Strachan R, Pang T, Needham B, Lui K, Ali F, Day AS, Appleton L, Moeeni V, Jaffe A, Ooi CY. Age-dependent variation of fecal calprotectin in cystic fibrosis and healthy children. J Cyst Fibros 2017; 16:631-6. [PMID: 28416415 DOI: 10.1016/j.jcf.2017.03.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/19/2017] [Accepted: 03/20/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Fecal calprotectin may be used as a non-invasive method to assess the effect of novel therapies on the gut in cystic fibrosis (CF). METHOD Stools from CF patients and healthy controls (HC) (0-10years old) were prospectively collected for evaluation of temporal trends. RESULTS 130 CF samples (64 subjects) and 114 HC samples (101 subjects) were collected. Overall, fecal calprotectin levels were different in CF patients and HC from 0 to 10years (P=0.0002). Fecal calprotectin in CF was significantly lower than HC from 0 to 1years (P=0.03) and demonstrated an upward trajectory until 4years. From >4 to 10years calprotectin was consistently higher in CF patients compared with HC (P=0.007). CONCLUSIONS Fecal calprotectin levels in children with CF and HC were age-dependent and had distinct trajectories. Careful interpretation of calprotectin is required if used in drug trials for CF, particularly in children less than 4years old.
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Abstract
Exocrine pancreatic insufficiency caused by chronic pancreatitis results from various factors which regulate digestion and absorption of nutrients. Pancreatic function has been extensively studied over the last 40 years, even if some aspects of secretion and gastrointestinal adaptation are not completely understood. The main clinical manifestations of exocrine pancreatic insufficiency are fat malabsorption, known as steatorrhea, which consists of fecal excretion of more than 6 g of fat per day, weight loss, abdominal discomfort and abdominal swelling sensation. Fat malabsorption also results in a deficit of fat-soluble vitamins (A, D, E and K) with consequent clinical manifestations. The relationships between pancreatic maldigestion, intestinal ecology and intestinal inflammation have not received particular attention, even if in clinical practice these mechanisms may be responsible for the low efficacy of pancreatic extracts in abolishing steatorrhea in some patients. The best treatments for pancreatic maldigestion should be re-evaluated, taking into account not only the correction of pancreatic insufficiency using pancreatic extracts and the best duodenal pH to permit optimal efficacy of these extracts, but we also need to consider other therapeutic approaches including the decontamination of intestinal lumen, supplementation of bile acids and, probably, the use of probiotics which may attenuate intestinal inflammation in chronic pancreatitis patients.
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