title: Association Between Fecal Calprotectin Levels and Small-bowel Inflammation Score in Capsule Endoscopy: A Multicenter Retrospective Study.
abstract: Accurate inflammation reporting in capsule endoscopy (CE) is important for diagnosis and monitoring of treatment of inflammatory bowel disease (IBD). Fecal calprotectin (FC) is a highly specific biomarker of gut inflammation. Lewis score (LS) was developed to standardize quantification of inflammation in small-bowel (SB) CE images.
  
  
  
  Multicenter retrospective study aiming to investigate correlation between LS and FC in a large group of patients undergoing CE for suspected or known small-bowel IBD, and to develop a model for prediction of CE results (LS) based on FC levels.
  
  
  
  Five academic centers and a district general hospital offering CE in UK, Finland, Sweden, Canada, and Israel. In total, 333 patients were recruited. They had small-bowel CE and FC done within 3 months.
  
  
  
  Overall, correlation between FC and LS was weak (r s: 0.232, P < 0.001). When two clinically significant FC thresholds (100 and 250 μg/g) were examined, the r s between FC and LS was 0.247 (weak) and 0.337 (moderate), respectively (P = 0.307). For clinically significant (LS ≥ 135) or negative (LS < 135) for SB inflammation, ROC curves gave an optimum cutoff point of FC 76 μg/g with sensitivity 0.59 and specificity 0.41.
  
  
  
  Retrospective design.
  
  
  
  LS appears to show low correlation with FC as well as other serology markers of inflammation. FC does not appear to be a reliable biomarker for significant small-bowel inflammation. Nevertheless, FC level ≥ 76 μg/g may be associated with appreciable visual inflammation on small-bowel CE in patients with negative prior diagnostic workup.
authors.affiliation: Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Koulaouzidis
authors.affiliation: Department of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Sipponen
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Artur
authors.initials: A
authors.lastname: Nemeth
authors.affiliation: Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Makins
authors.affiliation: Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Nadler
authors.affiliation: Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus.
authors.forename: Andry
authors.initials: A
authors.lastname: Giannakou
authors.affiliation: Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK. diana.e.yung@gmail.com.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Yung
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Gabriele Wurm
authors.initials: GW
authors.lastname: Johansson
authors.affiliation: Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Bartzis
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Thorlacius
authors.affiliation: Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Ernest G
authors.initials: EG
authors.lastname: Seidman
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.affiliation: Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
authors.forename: John N
authors.initials: JN
authors.lastname: Plevris
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
mesh_terms: D002097:C-Reactive Protein / Q000737:chemistry; D053704:Capsule Endoscopy; D005243:Feces / Q000737:chemistry* / Q000166:cytology; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D039841:Leukocyte L1 Antigen Complex / Q000737:chemistry*; D009000:Monocytes; D012189:Retrospective Studies
chemical_list: D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein
keywords: C-reactive protein; Capsule endoscopy; Fecal calprotectin; Lewis score; Monocyte count; Multicenter study; Small-bowel inflammation