Fecal calprotectin remains high during glucocorticoid therapy in children with inflammatory bowel disease.
OBJECTIVE
Fecal calprotectin is a promising marker for the assessment of gastrointestinal inflammation. Fecal calprotectin levels were followed-up in children with inflammatory bowel disease (IBD) who were introduced to glucocorticoid therapy. The aim of this study was to assess whether the changes in fecal calprotectin levels reflect therapeutic responses.


METHODS
Fecal calprotectin was measured by enzyme immunoassay in 57 children (mean age 9.8 years, range 0.9-18 years) who underwent colonoscopies (IBD n=31, non-IBD disease n=13, normal n=13) and followed-up in 15 children (mean age 13 years, range 3.6-18 years) who were introduced to glucocorticoid therapy because of active IBD at 0, 2, and 4 weeks and at 4-week intervals until one month after discontinuation of the therapy.


RESULTS
Fecal calprotectin was <100 microg/g in 70% of the children with normal findings on colonoscopy or a non-IBD disease. Fecal calprotectin was >100 microg/g in all but one child with active IBD and in 13/15 of those children who were introduced to glucocorticoids by the clinicians. Fecal calprotectin values decreased within 4 weeks in line with clinical improvement in 7 children and normalized in 4/15 children during the follow-up. Fecal calprotectin increased in 5/8 of the non-steroid-dependent children after discontinuation of glucocorticoids.


CONCLUSIONS
Fecal calprotectin is a sensitive marker for chronic colitis. In active disease treated with glucocorticoids, fecal calprotectin levels declined in line with the clinical improvement but seldom fell within the normal range, which suggests ongoing inflammation in a clinically silent disease. The measurement of fecal calprotectin may provide new tools for the assessment of the level of gut inflammation in children with chronic colitis in the follow-up of clinical responses.
Kolho
Kaija-Leena
KL
Hospital for Children and Adolescents, University of Helsinki, Finland. kaija-leena.kolho@helsinki.fi
Raivio
Taneli
T
Lindahl
Harry
H
Savilahti
Erkki
E
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000378:metabolism*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis* / Q000276:immunology; D008297:Male; D012680:Sensitivity and Specificity
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex