Serial fecal calprotectin changes in children with Crohn's disease on treatment with exclusive enteral nutrition: associations with disease activity, treatment response, and prediction of a clinical relapse.
BACKGROUND
Exclusive enteral nutrition (EEN) induces clinical remission in pediatric Crohn's disease (CD).


OBJECTIVE
This study explored changes in fecal calprotectin concentration during treatment with EEN.


METHODS
Fecal calprotectin was measured in 4 serial stool samples from CD children during EEN. The Pediatric Crohn's Disease Activity Index (PCDAI) and systemic markers of disease activity were measured at the beginning and end of treatment.


RESULTS
Fifteen CD children (7 girls; 11.6±2.3 y) participated. PCDAI decreased in 14 children and 7 children achieved clinical remission (PCDAI ≤10). Fecal calprotectin concentration decreased (30 d, P=0.014; 60 d, P<0.0001) only in those children who entered clinical remission (PCDAI ≤10). In the whole group mean calprotectin concentration at baseline (2158±642 mg/kg) was reduced by 975 mg/kg (95% confidence interval -1783; -167) after 30 days and 1700 mg/kg (95% confidence interval -2508; -892) on EEN completion. Only one child reached normal levels by the end of EEN. Decrease of pretreatment calprotectin levels by more than 18% after 30 days on EEN predicted clinical response at the end of EEN. Calprotectin levels at the end of EEN treatment did not predict the length of time lapsed to a future relapse.


CONCLUSIONS
In this pilot study calprotectin decreased in patients who achieved clinical remission and may be useful to predict response to treatment.
Gerasimidis
Konstantinos
K
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital of Sick Children, Glasgow, G3 8SJ, UK.
Nikolaou
Charoula Konstantia
CK
Edwards
Christine Ann
CA
McGrogan
Paraic
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000503:physiopathology / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis / Q000378:metabolism*; D008297:Male; D011237:Predictive Value of Tests; D012074:Remission Induction; D055502:Secondary Prevention; D016896:Treatment Outcome
D039841:Leukocyte L1 Antigen Complex