title: Levels of Fecal Calprotectin Are Associated With the Severity of Postoperative Endoscopic Recurrence in Asymptomatic Patients With Crohn's Disease.
abstract: OBJECTIVE
  Fecal calprotectin (fCal) is widely used as marker of gut inflammation and is strongly associated with the severity of endoscopic lesions in Crohn's disease (CD). We analyzed the relationships between levels of fCal and high-sensitivity C-reactive protein (hsCRP) and the presence and severity of postoperative endoscopic recurrence in asymptomatic CD patients (Harvey-Bradshaw index≤3).
  
  
  METHODS
  Blood and fecal samples were collected in consecutive asymptomatic CD patients (Harvey-Bradshaw index 0.85 ± 0.19, mean ± s.e.m.) who had undergone an ileocolonic resection. hsCRP and fCal were measured and a routine ileocolonoscopy was performed within 18 months (median 7 months) from resection, to detect endoscopic recurrence according to the Rutgeerts score.
  
  
  RESULTS
  Eighty-six patients were included in this prospective multicenter observational cohort. fCal concentrations differed significantly in patients with endoscopic recurrence when compared with those in endoscopic remission (mean ± s.e.m.: 473 ± 78 μg/g vs. 115 ± 18 μg/g; P<0.0001). The area under the receiver operating characteristic (ROC) curve to discriminate between patients in endoscopic remission and recurrence was 0.86 for fCal and lower for hsCRP (0.70). The best cutoff point for fCal to distinguish between endoscopic remission and recurrence was 100 μg/g as determined by the ROC curve, and its sensitivity, specificity, positive and negative predictive values (NPVs), as well as overall accuracy were 95%, 54%, 69%, 93%, and 77%, respectively.
  
  
  CONCLUSIONS
  Measurement of fCal concentrations is a promising and useful tool for monitoring asymptomatic CD patients after ileocolonic resection. Taking into account the high NPV of fCal, a threshold below 100 μg/g could avoid systematic ileocolonoscopies in 30% of patients from this population.
authors.affiliation: 1] Hospices Civils de Lyon, Department of Gastroenterology, Hopital Lyon-Sud, Pierre-Bénite, France [2] INSERM U1111, International Center for Research in Infectiology, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Boschetti
authors.affiliation: Hospices Civils de Lyon, Department of Gastroenterology, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Marc'harid
authors.initials: M
authors.lastname: Laidet
authors.affiliation: Hospices Civils de Lyon, Department of Gastroenterology, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Driffa
authors.initials: D
authors.lastname: Moussata
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hopital Beaujon, Paris 7 Université, Clichy, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stefanescu
authors.affiliation: Department of Gastroenterology, Hopital Nord, Saint-Etienne, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
authors.affiliation: Hospices Civils de Lyon, Department of Gastroenterology, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Gildas
authors.initials: G
authors.lastname: Phelip
authors.affiliation: Hospices Civils de Lyon, Department of Digestive Surgery, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
authors.affiliation: Hospices Civils de Lyon, Department of Digestive Surgery, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.affiliation: Hospices Civils de Lyon, Department of Digestive Surgery, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Francois
authors.affiliation: Laboratory of Biochemistry, Hospices Civils de Lyon, Hopital Lyon-Sud, Pierre-Bénite, France.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Drai
authors.affiliation: Department of Gastroenterology, Hopital Nord, Saint-Etienne, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Del Tedesco
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hopital Beaujon, Paris 7 Université, Clichy, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: 1] Hospices Civils de Lyon, Department of Gastroenterology, Hopital Lyon-Sud, Pierre-Bénite, France [2] INSERM U1111, International Center for Research in Infectiology, Lyon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Flourie
authors.affiliation: 1] Hospices Civils de Lyon, Department of Gastroenterology, Hopital Lyon-Sud, Pierre-Bénite, France [2] INSERM U1111, International Center for Research in Infectiology, Lyon, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Nancey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D003082:Colectomy; D003424:Crohn Disease / Q000378:metabolism / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein