Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: 1/23/2007
Publication Date: 2/4/2007
Citation: Shulman, R.J., Eakin, M., Tatevian, N. 2007. Fecal calprotectin and gastrointestinal (GI) permeability correlate with disease activity index, and histologic, endoscopic, and radiologic findings in children with crohn disease (CD) [abstract]. Gastroenterology. 132(Suppl.2):A649. Interpretive Summary:
Technical Abstract: Fecal calprotectin and permeability are noninvasive measures of GI inflammation and damage, respectively. However, there are scant data as to the possible association between the tests and CD disease activity in children. We hypothesized that levels of fecal calprotectin and permeability would correlate with disease activity index and histologic, endoscopic, and radiographic findings. Children with CD were identified from the Texas Children's Hospital Gastroenterology Clinic Database. The Pediatric CD Activity Index (PCDAI) was calculated at the time of study. Within two weeks of carrying out an ileocolonoscopy and biopsy and/or upper GI series with small bowel followthrough a random stool was collected for determination of fecal calprotectin and a permeability test was carried out to measure gastric/duodenal (sucrose/lactulose ratio), small intestinal (lactulose/mannitol ratio), and colonic (sucralose/lactulose ratio) permeability. Histology was graded 1-4 (normal to severe, acute vs chronic), ileocolonoscopy 1-3 (normal to mucosal disease/no ulcerations to mucosal disease/ulcerations), radiography 1-3 (normal to possibly abnormal to definitely abnormal). Forty-three children were studied (Mean +/- SEM age 13.9 +/- 0.3 yr, range 4-19). The PCDAI was 24.0 +/- 2.0. Fecal calprotectin (µg/g stool) was 1229 +/- 157 (normal <50). There was a significant positive correlation between fecal calprotectin and the PCDAI (P=0.02). There was no relationship between permeability measurements and the PCDAI. Results for histology, endoscopy, and radiography are given in the Table. Neither fecal calprotectin nor permeability correlated with gastric or colonic histology. We conclused that: 1) Both fecal calprotectin and permeability are abnormal in children with IBD; 2) Both fecal calprotectin and permeability reflect small intestinal histological inflammation, particularly chronic inflammation; 4) Fecal calprotectin appears useful as a noninvasive measure of small intestinal involvement whereas permeability appears useful as a measure of gastric/duodenal involvement.