title: Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents.
abstract: BACKGROUND
  Fecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children.
  
  
  METHODS
  Altogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age ≤18years were included.
  
  
  RESULTS
  Ileocecal resection (n=15), small bowel resection (n=6), or left hemicolectomy (n=1) was performed at median age of 15.1 (interquartile range 14.4-17.6) years. Following surgery, FC decreased significantly (659 vs. 103μg/g, p=0.001). During median follow-up of 5.7 (4.2-7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC >139μg/g at time of endoscopy or FC increase of 79μg/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC >101μg/g or increase of 21μg/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58-0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67-0.95) for histological recurrence.
  
  
  CONCLUSIONS
  FC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients.
authors.affiliation: Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki, Finland. Electronic address: maria.hukkinen@helsinki.fi.
authors.forename: Maria
authors.initials: M
authors.lastname: Hukkinen
authors.affiliation: Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki, Finland; Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
authors.affiliation: Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki, Finland; Section of Pediatric Gastroenterology, Children's Hospital, University of Helsinki, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Merras-Salmio
authors.affiliation: Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Koivusalo
authors.affiliation: Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
authors.affiliation: Section of Pediatric Gastroenterology, Children's Hospital, University of Helsinki, Finland.
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D003082:Colectomy; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex
keywords: Bowel resection; Endoscopy; Inflammatory bowel disease; Pediatrics; Stool tests