P150 Low diagnostic accuracy of faecal calprotectin to predict mucosal inflammation in Crohn’s disease patients with active perianal fistulas

Abstract Background The endoscopic healing index (EHI, Monitr, Prometheus Biosciences, San Diego, CA) is a serum-based biomarker panel available for identifying mucosal inflammation in Crohn’s disease.[1] We aimed to study its performance for identifying mucosal inflammation in ulcerative colitis. Methods EHI was analysed on serum samples paired with endoscopies from adult patients (≥18 years) participating in a prospective biobank (June 2014 to December 2017). Area under receiver operating characteristic curves (AUROC) were used to assess the accuracy of EHI for endoscopic improvement (EI; Mayo endoscopic sub-score [MES] 0–1) and endoscopic remission (ER; MES 0). Sensitivity for EHI was calculated using a cut-off previously identified for Crohn’s disease which optimised performance for ruling out endoscopic activity (20 points). Alternative cut-offs were explored. Results A total of 114 patients were included, with an overall prevalence of 56% and 44% for EI and ER. The AUROC was 0.79 (95% CI 0.70–0.87) for EI and 0.70 (95% CI 0.61–0.80) for ER. A cut-off of 20 points had a sensitivity of 94% (95% CI 83–99%) for ruling out moderate to severe (MES 2–3) endoscopic activity, and a sensitivity of 84% (95% CI 72–92%) for ruling out mild to severe (MES 1–3) endoscopic activity. A cut off of 40 points or higher had > 90% specificity for ruling in moderate to severe (MES 2–3) or mild to severe (MES 1–3) endoscopic activity. (Table 1) Conclusion EHI has favourable accuracy in identifying the presence of mucosal inflammation in patients with ulcerative colitis. Although it was not developed and validated for ulcerative colitis, further validation is warranted. Reference

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P244 Validation of the Red Flags index for early diagnosis of Crohn’s disease: A prospective general practitioner study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.373 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S267-S269

Author(s):

G Fiorino ◽

D Gilardi ◽

S Bonovas ◽

A Di Sabatino ◽

E Angeli ◽

...

Keyword(s):

Crohn’S Disease ◽

General Practitioner ◽

Crohn's Disease ◽

Early Diagnosis ◽

Diagnostic Accuracy ◽

Diagnostic Delay ◽

Diagnostic Strategy ◽

Red Flags ◽

Faecal Calprotectin ◽

Predictive Values

Abstract Background A diagnostic delay >12 months is frequent in Crohn’s disease (CD), and associated with lower therapeutic response rates and worse outcomes. The Red Flags index, a simple tool to help to identify early CD and reduce diagnostic delay, was recently developed. We aimed to assess its accuracy for early diagnosis of CD patients. Methods Consecutive adult patients, suffering from intestinal symptoms and having no medical history of any gastrointestinal disease, referring to the General Practitioner (GP) were screened. Patients should have at least one of the following symptoms: chronic abdominal pain, chronic diarrhoea, nocturnal diarrhoea, unexpected weight loss, or perianal lesions. The GPs administered the Red Flags questionnaire to each eligible patient. Then, all patients were referred to the nearest participating Centre to confirm or exclude the diagnosis of CD. IBD specialists were blinded to the results of the questionnaire. The first-line examination systematically included blood cell count, serum C-reactive protein, faecal calprotectin (FC) and abdominal ultrasound, according to routine practice. If required to confirm CD, second-line examinations were planned (i.e. colonoscopy and cross-sectional imaging). Sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) of the Red Flags index were estimated. Patients lost to follow-up were included in the analysis by a non-responder imputation assuming they were negative for CD. Results From 11/2016 to 11/2019, 64 GPs participated (Bergamo: 52, Pavia: 12, in charge of a population of 93,000 subjects) and 112 patients over a mean number of 53,568 subjects screened were included in the study (median age 35 years, range: 18–69, 37% males). Only 66 subjects (59%) completed the study. The prevalence of CD was 3.6% in the study population (4 of 112 subjects; 3 with B1, and 1 with B2 phenotype). The Red Flags index had Se=0.50 (95% CI: 0.07–0.93), Sp = 0.58 (0.49–0.68), PPV=0.04 (0.01–0.15), and NPV=0.97 (0.89–1.00). A combined diagnostic strategy with faecal calprotectin (in which a subject was considered ‘positive’ if having RFI ≥8 and/or FC >250) resulted in significantly improved diagnostic accuracy: Se=1.00 (0.29–1.00), Sp = 0.72 (0.55–0.85), PPV=0.21 (0.05–0.51), NPV=1.00 (0.88–1.00); however, only 42 subjects (with 3 confirmed cases of CD) were available for this analysis. Conclusion The diagnostic accuracy of the Red Flags questionnaire was moderate when applied alone to a primary care setting. However, the combined diagnostic strategy of the Red Flags index and faecal calprotectin has given promising results. Further research is warranted on how to best identify patients with early clinical onset of CD.

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Can faecal calprotectin predict relapse in inflammatory bowel disease: a mini review

Frontline Gastroenterology ◽

10.1136/flgastro-2016-100686 ◽

2016 ◽

Vol 9 (1) ◽

pp. 23-28 ◽

Cited By ~ 5

Author(s):

T S Chew ◽

J C Mansfield

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Calcium Binding ◽

Inflammatory Cells ◽

Mucosal Inflammation ◽

Faecal Calprotectin ◽

Inflammatory Bowel

Crohn's disease and ulcerative colitis are chronic inflammatory disorders affecting the gastrointestinal tract. Faecal calprotectin is a protein complex of the S-100 family of calcium-binding proteins present in inflammatory cells that can be measured in stool samples, which act as a biomarker for bowel inflammation. Elevated faecal calprotectin has been shown to reflect the presence of ongoing mucosal inflammation, which improves with mucosal healing. The aim of this review was to evaluate the available evidence on the ability of faecal calprotectin to predict a relapse in inflammatory bowel disease. Multiple retrospective studies have shown that patients who relapse have significantly higher levels of calprotectin in their stool compared with non-relapsers, especially in ulcerative colitis. Elevated faecal calprotectin postoperatively in Crohn's disease was also shown to be indicative of a relapse. However, the association of a raised faecal calprotectin and relapse is not universal and may be explained by the different patterns of mucosal inflammatory activity that exist. In conclusion, we put forward our hypothesis that changes such as a rise in faecal calprotectin levels may be more predictive of a relapse than absolute values.

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Strategies to Distinguish Perianal Fistulas Related to Crohn’s Disease From Cryptoglandular Disease: Systematic Review With Meta-Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab286 ◽

2021 ◽

Author(s):

Kevin Chin Koon Siw ◽

Jake Engel ◽

Samantha Visva ◽

Ranjeeta Mallick ◽

Ailsa Hart ◽

...

Keyword(s):

Systematic Review ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Diagnostic Accuracy ◽

Quality Assessment ◽

Fixed Effects ◽

Meta Analysis ◽

Pelvic Mri ◽

Perianal Fistulas ◽

Imaging Characteristics

Abstract Background Management of perianal fistulas differs based on fistula type. We aimed to assess the ability of diagnostic strategies to differentiate between Crohn’s disease (CD) and cryptoglandular disease (CGD) in patients with perianal fistulas. Methods We performed a diagnostic accuracy systematic review and meta-analysis. A systematic search of electronic databases was performed from inception through February 2021 for studies assessing a diagnostic test’s ability to distinguish fistula types. We calculated weighted summary estimates with 95% confidence intervals for sensitivity and specificity by bivariate analysis, using fixed effects models when data were available from 2 or more studies. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess study quality. Results Twenty-one studies were identified and included clinical symptoms (2 studies; n=154), magnetic resonance imaging (MRI) characteristics (3 studies; n=296), ultrasound characteristics (7 studies; n=1003), video capsule endoscopy (2 studies; n=44), fecal calprotectin (1 study; n=56), and various biomarkers (8 studies; n=440). MRI and ultrasound characteristics had the most robust data. Rectal inflammation, multiple-branched fistula tracts, and abscesses on pelvic MRI and the Crohn’s ultrasound fistula sign, fistula debris, and bifurcated fistulas on pelvic ultrasonography had high specificity (range, 80%-95% vs 89%-96%) but poor sensitivity (range, 17%-37% vs 31%-63%), respectively. Fourteen of 21 studies had risk of bias on at least 1 of the Quality Assessment of Diagnostic Accuracy Studies domains. Conclusions Limited high-quality evidence suggest that imaging characteristics may help discriminate CD from CGD in patients with perianal fistulas. Larger, prospective studies are needed to confirm these findings and to evaluate if combining multiple diagnostic tests can improve diagnostic sensitivity.

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