Fecal calprotectin and endoscopic scores: The cornerstones in clinical practice for evaluating mucosal healing in inflammatory bowel disease

Table 5 Practical pearls to the use of fecal calprotectin in ulcerative colitis

FC should be measured before starting or optimizing any therapy for UC, at the end of induction therapy, every 2–4 mo in patients being treated for active disease, and every 6–12 mo during the maintenance therapy in patients in symptomatic remission; and in case of clinical relapse of disease[94]

FC values of < 150 μg/g typically reflect remission, FC values ranging from 150–250 μg/g are a grey zone, and cutoff values of > 200–300 μg/g suggest the presence of active disease[11]

Prior to symptoms based on the diagnosis of a flare, FC is reported to be elevated approximately 8 wk in advance. Conversely, patients who maintain remission usually present FC concentrations persistently < 60 μg/g[95]

FC is a reliable biomarker to evaluate the response to treatment. A post-induction FC concentration of ≤ 250 µg/g vs > 250 µg/g is associated with a substantially higher probability of achieving clinical, endoscopic, and histologic remission[46]

FC is a valuable marker of endoscopic inflammation, being useful in distinguishing Mayo endoscopic subscores of 0 from 1–3 using the FC cutoff of 60 μg/g[96]

Persistent high values of FC are an important predictor of disease flare in asymptomatic patients[94]

In patients with mild-to-moderate UC who achieve complete endoscopic healing, a FC cutoff value between 75 and 100 µg/g can be used to discriminate patients with ongoing microscopic inflammation from those with histologic remission[97]

In patients with ileal pouch-anal anastomosis, FC values of > 100 µg/g are suggestive of endoscopic or histological inflammation of the pouch (e.g., pouchitis)[57]

Adapted from D'Amico et al[94], Turner et al[11], Yamamoto et al[95], D'Amico et al[57], Dulai et al[46], Suttichaimongkol et al[96], D'Amico et al[94], and Stevens et al[97]. FC: Fecal calprotectin; UC: Ulcerative colitis.