title: Low fecal calprotectin predicts sustained clinical remission in inflammatory bowel disease patients: a plea for deep remission.
abstract: OBJECTIVE
  Mucosal healing has become the treatment goal in patients with ulcerative colitis (UC) and Crohn's disease (CD). Whether low fecal calprotectin levels and histological healing combined with mucosal healing is associated with a further reduced risk of relapses is unknown.
  
  
  METHODS
  Patients with CD, UC or inflammatory bowel disease-unclassified (IBD-U) scheduled for surveillance colonoscopy collected a stool sample prior to bowel cleansing. Only patients with mucosal healing (MAYO endoscopic score of 0) were included. Fecal calprotectin was measured using a quantitative enzyme-linked immunosorbent assay (R-Biopharm, Germany). Biopsies were obtained from four colonic segments, and histological disease severity was assessed using the Geboes scoring system. Patients were followed until the last outpatient clinic visit or the development of a relapse, which was defined as IBD-related hospitalization, surgery or step-up in IBD medication.
  
  
  RESULTS
  Of the 164 patients undergoing surveillance colonoscopy, 92 patients were excluded due to active inflammation or missing biopsies. Of the remaining 72 patients (20 CD, 52 UC or IBD-U), six patients (8%) relapsed after a median follow-up of 11 months (range 5-15 months). Median fecal calprotectin levels at baseline were significantly higher for patients who relapsed compared with patients who maintained remission (284 mg/kg vs. 37 mg/kg. p < 0.01). Fecal calprotectin below 56 mg/kg was found to optimally predict absence of relapse during follow-up with 64% sensitivity, 100% specificity, 100% negative predictive value and 20% positive predictive value. The presence or absence of active inflammation determined by Geboes cut-off score of 3.1 was less strongly associated with the risk of relapse (64% sensitivity, 33% specificity, 9% negative predictive value and 92% positive predictive value.
  
  
  CONCLUSIONS
  Low calprotectin levels identify IBD patients who remain in stable remission during follow-up.
authors.affiliation: University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Mooiweer
authors.affiliation: University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Severs
authors.affiliation: University Medical Center Utrecht, Department of Pathology, Utrecht, Netherlands.
authors.forename: Marguerite E I
authors.initials: ME
authors.lastname: Schipper
authors.affiliation: University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands.
authors.forename: Herma H
authors.initials: HH
authors.lastname: Fidder
authors.affiliation: University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands.
authors.forename: Robert J F
authors.initials: RJ
authors.lastname: Laheij
authors.affiliation: University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands B.Oldenburg@umcutrecht.nl.
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D003113:Colonoscopy; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex
keywords: IBD; calprotectin; mucosal healing; relapse