title: Limitations of fecal calprotectin at diagnosis in untreated pediatric Crohn's disease.
abstract: BACKGROUND
  Fecal Calprotectin (FC) is a validated screening test for intestinal inflammation in Crohn's disease (CD). The objective of the study was to prospectively evaluate the limitations of FC for identifying CD in newly diagnosed untreated pediatric patients and to assess the association of FC levels with disease location and serum inflammatory markers.
  
  
  METHODS
  Consecutive children with new onset untreated CD participating in the ongoing ESPGHAN GROWTH CD study were evaluated at diagnosis for disease activity, extent, C-reactive protein (CRP), and FC.
  
  
  RESULTS
  In all, 60 children met the inclusion criteria (mean age 12.6 ± 4.6 years,), 25 (42%) with mild disease, 17 (28%) moderate disease, and 18 (30%) severe disease. Twenty-seven (45%) had small bowel disease only. Median FC levels did not differ between children with small bowel only (2198 μg/g interquartile range [IQR] 696-2400) and those with colonic involvement (with or without small bowel disease; 2400 μg/g (IQR 475-2400) (P = 0.76). FC was elevated in 95% of patients, in comparison to CRP (86%) and erythrocyte sedimentation rate (ESR) (83%). Three children (5%) who had normal calprotectin levels also had low or normal CRP and/or ESR. There was no correlation between calprotectin levels and either the pediatric CD activity index (r = -0.11; P = 0.94) or physicians global assessment.
  
  
  CONCLUSIONS
  FC levels in active disease confined to the small bowel were elevated in the vast majority of children and site of disease was not a confounding factor in this setting. Patients with low FC had a trend toward low levels of inflammatory markers as well. We did not find a significant correlation between FC and clinical indices of activity.
authors.affiliation: Pediatric Gastroenterology Unit, Rambam Medical Center, Technion, Faculty of Medicine, Haifa, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Shaoul
authors.forename: Marlgozata
authors.initials: M
authors.lastname: Sladek
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Anders
authors.initials: A
authors.lastname: Paeregaard
authors.forename: Gabor
authors.initials: G
authors.lastname: Veres
authors.forename: Gigi Veereman
authors.initials: GV
authors.lastname: Wauters
authors.forename: Johanna
authors.initials: J
authors.lastname: Escher
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.forename: Paolo
authors.initials: P
authors.lastname: Lionetti
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staino
authors.forename: Kaija Leena
authors.initials: KL
authors.lastname: Kolho
authors.forename: Lissy
authors.initials: L
authors.lastname: de Ridder
authors.forename: Federica
authors.initials: F
authors.lastname: Nuti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Orit
authors.initials: O
authors.lastname: Sheva
authors.forename: Arie
authors.initials: A
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis* / Q000378:metabolism; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis*; D007421:Intestine, Small / Q000378:metabolism / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex