Fecal Calprotectin Thresholds to Predict Endoscopic Remission Using Advanced Optical Enhancement Techniques and Histological Remission in IBD Patients

Abstract Background Fecal calprotectin (FC) is a common surrogate marker of mucosal healing (MH) in patients with ulcerative colitis (UC) and Crohn’s disease (CD). We investigated the optimum FC thresholds for defining endoscopic remission (ER) and histological remission (HR) using advanced endoscopic techniques. Patients and Methods In this cross-sectional study, we collected clinical, endoscopic, histological data, and FC from 76 UC and 41 CD patients. Receiver operating characteristic curves were created to evaluate the optimum cut-off of FC to predict ER evaluated by Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and modified PICaSSO (Paddington International Virtual Chromoendoscopy Score) for UC patients and Simple Endoscopic Score (SES-CD) in CD patients; and HR was scored by the Robarts Histology Index (RHI) and Nancy Index for UC and modified Riley for CD. Results In UC patients, the best thresholds of FC to identify ER calculated with MES, UCEIS, and modified PICaSSO were 112, 148, and 161 mcg/g with accuracy of 86.9% 86.8%, and 81.6%, respectively. The best value of FC to predict HR was 112 mcg/g and 172 mcg/g with accuracy of 84.2% and 81.6% for RHI and Nancy Index, respectively. In CD patients, the best cut-off of FC to predict ER was 96 mcg/g with accuracy of 82.9%. The HR was best predicted by an FC value of 225 mcg/g with accuracy of 75.6%. Conclusions The FC value threshold between 112 and 172 mcg/g could identify ER and HR in UC patients, whereas a value under 225 mcg/g should be considered for CD patients.

Download Full-text

Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000662 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000662

Author(s):

Sen Yagi ◽

Shinya Furukawa ◽

Kana Shiraishi ◽

Yu Hashimoto ◽

Kazuhiro Tange ◽

...

Keyword(s):

Ulcerative Colitis ◽

Serum Albumin ◽

Clinical Outcomes ◽

Clinical Remission ◽

Acute Inflammation ◽

Japanese Patients ◽

Cross Sectional Study ◽

Mucosal Healing ◽

High Serum ◽

Cross Sectional

ObjectiveSerum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association.DesignThis cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0–1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression.ResultsRates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found.ConclusionIn Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH.

Download Full-text

Association Between Platelet Count and Mucosal Healing in Japanese Patients With Ulcerative Colitis: Cross-Sectional Study

10.21203/rs.3.rs-60855/v1 ◽

2020 ◽

Author(s):

Shinya Furukawa ◽

Sen Yagi ◽

Kana Shiraishi ◽

Kenichirou Mori ◽

Tomoyuki Ninomiya ◽

...

Keyword(s):

Ulcerative Colitis ◽

Platelet Count ◽

Japanese Patients ◽

Cross Sectional Study ◽

Mucosal Healing ◽

Confounding Factors ◽

Cross Sectional ◽

Factor Α ◽

Very High ◽

Necrosis Factor

Abstract Background: Mucosal healing (MH) has been indicated as the therapeutic goal for ulcerative colitis (UC). Platelet count is known as an inflammation evaluation. However, the association between platelet count and MH among patients with UC is still scarce. We therefore assessed this issue among Japanese patients with UC.Methods: The study subjects consisted of 345 Japanese patients with UC. Platelet count was divided into quartiles on the basis of the distribution of all study subjects (low, moderate, high, and very high). Several endoscope specialists were responsible for evaluating MH and partial MH, which was defined as a Mayo endoscopic subscore of 0 and 0-1, respectively. Estimations of crude odds ratios (ORs) and their 95% confidence intervals (CIs) for partial MH and MH in relation to platelet count were performed using logistic regression analysis. Age, sex, CRP, steroid use, and anti-Tumor necrosis factor α (TNFα) preparation were selected a priori as potential confounding factors.Results: The percentage of partial MH and MH were 63.2 and 26.1%, respectively. Moderate and very high was independently inversely associated with partial MH (moderate: OR 0.40 [95%CI: 0.19-0.810], very high: OR 0.37 [95%CI: 0.17-0.77], p for trend= 0.034). Similarly, moderate, high, and very high were independently inversely associated with MH (moderate: OR 0.37 [95% CI: 0.18-0.73], high: OR 0.41 [95% CI: 0.19-0.83], and very high: OR 0.45 [95% CI: 0.21-0.94], p for trend = 0.033) after adjustment for confounding factors.Conclusions: Among patients with UC, platelet count was independently inversely associated with MH.

Download Full-text

Effectiveness of treatment of moderate ulcerative colitis with prolonged mesalazine in real clinical practice

Medical Council ◽

10.21518/2079-701x-2021-15-144-151 ◽

2021 ◽

pp. 144-151

Author(s):

O. V. Knyazev ◽

A. V. Kagramanova ◽

A. A. Lishchinskaya

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Topical Therapy ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Prolonged Release ◽

Mayo Score ◽

Endoscopic Remission ◽

Oral Mesalazine ◽

High Doses

Introduction. Ulcerative colitis (UC) is one of the severe therapeutic diseases. High doses of oral granular mesalazine are required to maintain clinical and endoscopic remission of UC, which may be sufficient and supposedly more acceptable for patients, as some studies showed that adherence to topical therapy is significantly lower than to oral 5-ASA drugs.Objective of the study. To evaluate the efficacy of therapy of patients with moderate left-sided ulcerative colitis (UC) and pancolitis receiving prolonged-release ethylcellulose-coated mesalazine.Materials and methods. The evaluation of the outcomes of treatment of UC patients who received prolonged-release mesalazine was carried out. We examined 87 patients with UC who received granular ethylcellulose-coated mesalazine, of those 38 (43.7%) men and 49 (56.3%) women. The average age of the enrolled patients was 38.3 ± 12.6 years.Results and discussion. After 2 weeks from the beginning of therapy with prolonged-release mesalazine, the majority of patients – 71 (81.6%) responded to the therapy. After 12 weeks, 71 (81.6%) of 87 UC patients, who responded to therapy with prolongedrelease mesalazine, remained in clinical remission. On average, the Mayo score in the group decreased from 7.6 ± 0.99 to 2.6 ± 0.25 points. There was a significant decrease in CRP, ESR, leukocytosis, and fecal calprotectin. After 26 weeks, Mayo score in the group of patients remained on average at the level of 2.2–2.3 points. The number of UC patients with colon mucosal healing was 32 (36.8%) patients. A year after the start of therapy with prolonged-release mesalazine, 69 (79.3%) UC patients who responded to therapy had a clinical remission, of those 32 (36.8%) patients had a clinical and endoscopic remission. During the year of observation, no case of surgical intervention or re-hospitalization due to exacerbation of the disease was recorded in patients with UC who achieved remission.Conclusions. Treatment of moderate active UC should begin with oral mesalazine ≥ 3 g per day in combination with topical mesalazine. The prolonged-release mesalazines are the most preferred

Download Full-text

Relationship between Microalbuminuria and Disease Activity in Patients with Ulcerative Colitis

Middle East Journal of Digestive Diseases ◽

10.15171/mejdd.2020.161 ◽

2019 ◽

Vol 12 (1) ◽

pp. 34-38

Author(s):

Kourosh Masnadi Shirazi ◽

Sima Khayati ◽

Maryam Baradaran Binazir ◽

Zeinab Nikniaz

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Fecal Calprotectin ◽

Cross Sectional Study ◽

Inactive Disease ◽

Cross Sectional ◽

Non Invasive ◽

The Mean

BACKGROUND Introducing a non-invasive method for determining disease activity is important in patients with ulcerative colitis (UC). So in this study, we aimed to assess the association between disease activity index and microalbuminuria in patients with UC. METHODS In the present cross-sectional study, 84 patients with UC were selected. The disease activity was calculated by the partial Mayo clinic score. Microalbuminuria was assessed using the immunoturbidimetric method in a first-voided sample in the morning in two consecutive days and the mean of these two measurements was reported as urinary microalbumin level. Serum C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fecal calprotectin were measured respectively using conventional turbidimetric immunoassay, Westergren method, and ELISA methods. RESULTS The mean age of the participants was 40.01 ± 12.85 years, 60.8% of them were female and 53.5% had microalbuminuria. The frequency of microalbuminuria was significantly higher in patients with active compared with inactive inflammatory bowel disease (IBD). There were significant differences between the patients with active and inactive disease regarding CRP, ESR, and calprotectin (p < 0.001). Moreover, there was a strong correlation between microalbuminuria and CRP (r = 0.89, p < 0.001), ESR (r = 0.92, p < 0.001), and calprotectin (r = 0.91, p < 0.001). CONCLUSION Microalbuminuria could be used as a non-invasive marker of disease activity in patients with UC.

Download Full-text

P545 Calprotectin at week 12 is a predictor for histological remission in ulcerative colitis patients treated with Vedolizumab

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.666 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S515-S516

Author(s):

D Rubstov ◽

P Kakkadasam Ramaswamy ◽

J Edwards ◽

D Shukla ◽

L Willmann ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Real World Setting ◽

Endoscopic Remission ◽

Endoscopic Score ◽

Histological Activity ◽

Maintenance Of Remission ◽

Histological Remission ◽

Endoscopic Assessment

Abstract Background Vedolizumab (VDZ) is a gut-specific α4β7 integrin antagonist that has demonstrated efficacy for induction and maintenance of remission in moderate to severe ulcerative colitis (UC). The aim of this study was to assess the rates of histological remission (HR) in a real-world setting and to identify predictors for histological remission. Methods Retrospective cohort study of all UC patients (≥18 years) initiated on VDZ from 2016 to 2020 was completed. Clinical, biochemical, endoscopic and histologic data were collected. All patients received standard induction therapy with VDZ 300 mg IV at Weeks 0, 2, and 6 and maintained on an 8-weekly regimen. Dose was escalated to a every 4-weekly regimen as per physician’s discretion. A 52-week follow-up was completed on all patients. Endoscopic assessment was carried out between 24 and 52 weeks after commencing VDZ. Histological activity was graded as per Nancy index and histological remission was defined as Nancy grade 0. Endoscopic remission was defined as Mayo endoscopic score = 0. Clinical remission was defined as SCCAI ≤ 5. Results A total of 51 patients [55% female, median age 48 years (IQR 35–60)] were included. 16/51 (34%) were anti-TNF exposed. In 30/51 (59%) patients VDZ was combined with steroids at induction and by week 12 steroids were completely tapered in 14/30 (46.7%) patients. At weeks 12, 24 and 52, 89.6%, 87% and 97.5% of patients, respectively, were in clinical remission. 19/37 (51.3%) patients were in endoscopic remission at end of follow up. Median Nancy score prior to commencing VDZ was 3 (IQR: 2–4) and the median Nancy score at end of follow up was 1 (IQR: 0–2). 19/37 (51.3%) patients achieved HR; 3 patients who were in HR at the time of commencement of VDZ remained in HR at the end of follow up. Median baseline faeces calprotectin (FC) was 320 mcg/g (IQR 45–1000) and was similar in patients who achieved HR and those who did not. Median FC at 12 weeks was 155 mcg/g (45–720) and was significantly lower in patients who achieved HR when compared to patients who did not achieve histological remission (45 vs 420, p 0.028). FC at week 12 predicted histological remission (AUC =0.8667). FC ≥ 200mcg/g at week 12 predicted failure to achieve HR with sensitivity 70%, specificity 100%, PPV 100%, NPV 75%, accuracy 84%. Conclusion Vedolizumab is effective in achieving histological remission and FC ≥ 200 mcg/g at week 12 accurately predicts failure to achieve HR in patients treated with VDZ.

Download Full-text

Association between platelet count and mucosal healing in Japanese patients with ulcerative colitis: a cross-sectional study

BMC Gastroenterology ◽

10.1186/s12876-020-01538-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shinya Furukawa ◽

Sen Yagi ◽

Kana Shiraishi ◽

Kenichirou Mori ◽

Tomoyuki Ninomiya ◽

...

Keyword(s):

Ulcerative Colitis ◽

Platelet Count ◽

A Priori ◽

Japanese Patients ◽

Cross Sectional Study ◽

Mucosal Healing ◽

Confounding Factors ◽

Cross Sectional ◽

Factor Α ◽

Very High

Abstract Background Mucosal healing (MH) has been indicated as the therapeutic goal for ulcerative colitis (UC). Platelet count is known as an inflammation evaluation. However, the association between platelet count and MH among patients with UC is still scarce. We therefore assessed this issue among Japanese patients with UC. Methods The study subjects consisted of 345 Japanese patients with UC. Platelet count was divided into quartiles on the basis of the distribution of all study subjects (low, moderate, high, and very high). Several endoscope specialists were responsible for evaluating MH and partial MH, which was defined as a Mayo endoscopic subscore of 0 and 0–1, respectively. Estimations of crude odds ratios (ORs) and their 95% confidence intervals (CIs) for partial MH and MH in relation to platelet count were performed using logistic regression analysis. Age, sex, CRP, steroid use, and anti-Tumor necrosis factor α (TNFα) preparation were selected a priori as potential confounding factors. Results The percentage of partial MH and MH were 63.2 and 26.1%, respectively. Moderate and very high was independently inversely associated with partial MH (moderate: OR 0.40 [95%CI 0.19–0.810], very high: OR 0.37 [95%CI 0.17–0.77], p for trend = 0.034). Similarly, moderate, high, and very high were independently inversely associated with MH (moderate: OR 0.37 [95% CI 0.18–0.73], high: OR 0.41 [95% CI 0.19–0.83], and very high: OR 0.45 [95% CI 0.21–0.94], p for trend = 0.033) after adjustment for confounding factors. Conclusions Among patients with UC, platelet count was independently inversely associated with MH

Download Full-text

Su1216 Low Fecal Calprotectin Correlates With Histological Remission and Mucosal Healing in Ulcerative Colitis and Colonic Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(15)31487-6 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-441 ◽

Cited By ~ 1

Author(s):

Eran Zittan ◽

Orlaith Kelly ◽

Richard Kirsch ◽

Jane Burns ◽

Joanne M. Stempak ◽

...

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Histological Remission

Download Full-text

Lymphocyte-to-Monocyte Ratio as a Marker for Endoscopic Activity in Ulcerative Colitis

Immuno ◽

10.3390/immuno1040024 ◽

2021 ◽

Vol 1 (4) ◽

pp. 360-368

Author(s):

Natsuki Ishida ◽

Satoru Takahashi ◽

Yusuke Asai ◽

Takahiro Miyazu ◽

Satoshi Tamura ◽

...

Keyword(s):

Ulcerative Colitis ◽

Roc Analysis ◽

Operating Characteristic ◽

Occult Blood ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Reactive Protein ◽

Lymphocyte To Monocyte Ratio ◽

Endoscopic Score ◽

The Relationship

Leukocyte subtypes can be used to evaluate the severity of ulcerative colitis (UC). In this study, we examined the relationship between the lymphocyte-to-monocyte ratio (LMR) and the Mayo endoscopic score (MES) in assessing endoscopic activity in UC. Eighty-nine samples of leukocyte subtypes and biomarkers, including fecal calprotectin (FC), the fecal immunochemical occult blood test (FIT), and C-reactive protein (CRP), from 71 patients with UC were retrospectively investigated, along with the MES. The MES was significantly correlated with the LMR, FC, the FIT, and CRP. There were significant differences in the LMR, FC, the FIT, and CRP between groups with an MES < 1 and >2 (p = 0.001, p = 0.003, p < 0.001, and p < 0.001, respectively). In the receiver operating characteristic (ROC) analysis for predicting mucosal healing (MES 0 or 1), the areas under the curve (AUCs) for the LMR, FC, the FIT, and CRP, were 0.712, 0.860, 0.908, and 0.796, respectively. In the analysis of patients without immunomodulators, the correlation of the MES with the LMR and CRP was significant. The LMR can be used to assess endoscopic activity in UC, particularly in patients without immunomodulators.

Download Full-text