Fecal calprotectin mirrors inflammation of the distal ileum and bowel function after restorative proctocolectomy for pediatric-onset ulcerative colitis.
BACKGROUND
The goal was to cross-sectionally assess fecal calprotectin after restorative proctocolectomy for pediatric-onset ulcerative colitis (UC).


METHODS
Fecal calprotectin, histology of the distal ileum, inflammation biochemistry, episodes of pouchitis, and bowel function were cross-sectionally determined at early adulthood in 32 patients who had undergone proctocolectomy with ileoanal anastomosis for UC at a mean (SD) age of 12.0 +/- 4.1 years.


RESULTS
A total of 15 (47%) patients showed increased (>100 microg/g) fecal calprotectin (669 +/- 866 microg/g), although their serum C-reactive protein (5.2 +/- 3.8 mg/L), erythrocyte sedimentation rate (13 +/- 13 mm/h), and white blood cell count (6.7 +/- 1.7 E9/L) were normal or slightly elevated. Calprotectin correlated positively with the histological neutrophil count of the distal ileum (r = 0.715; P < 0.001), the frequency of pouchitis (r = 0.468; P < 0.01), and with the maximum daily frequency of bowel actions (r = 0.610; P < 0.001). Mean fecal calprotectin was 71 +/- 50 microg/g among patients with no history of pouchitis (n = 10), 290 +/- 131 microg/g among patients with a single episode of pouchitis (n = 15), and 832 +/- 422 microg/g among those with recurrent pouchitis (P = 0.019 between recurrent pouchitis and no pouchitis). Sensitivity, specificity, positive predictive value, and negative predictive value for fecal calprotectin concentration over 300 microg/g to detect recurrent pouchitis were 57%, 92%, 67%, and 89%, respectively.


CONCLUSIONS
Neutrophilic inflammation of the distal ileum, as reflected by fecal calprotectin, is common after restorative proctocolectomy for pediatric-onset UC.
Pakarinen
Mikko P
MP
Section of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Finland. mikko.pakarinen@hus.fi
Koivusalo
Antti
A
Natunen
Johanna
J
Ashorn
Merja
M
Karikoski
Riitta
R
Aitola
Petri
P
Rintala
Risto J
RJ
Kolho
Kaija-Leena
KL
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000276:immunology / Q000378:metabolism* / Q000601:surgery*; D003430:Cross-Sectional Studies; D003672:Defecation; D005243:Feces; D005260:Female; D006801:Humans; D007082:Ileum / Q000276:immunology / Q000378:metabolism / Q000601:surgery; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D019449:Pouchitis / Q000276:immunology / Q000378:metabolism* / Q000601:surgery*; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative; D020127:Recovery of Function / Q000276:immunology; D011795:Surveys and Questionnaires; D055815:Young Adult
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex