Relevance of fecal calprotectin and lactoferrin in the post-operative management of inflammatory bowel diseases

Table 2 Studies evaluating fecal calprotectin and lactoferrin in operated ulcerative colitis patients

Ref.	FC/FL	Method	No. of patients (No. of patients with inflammation of the pouch) and type of disease	Aim	Best cut-off	Sens %	Spec %	Main findings
Thomas et al[39]	FC	ELISA	24 (9) UC and familial polyposis coli	Comparison between single and 24-h stool collections in patients with and without pouchitis (endoscopic, histologic and immunohistochemical indeces)	/	/	/	Mean first morning stool concentration correlated with 24-h collection Levels of FC were significantly higher in patients with pouchitis Correlation with % of mature granulocytes and activated macrophages
Johnson et al[40]	FC	ELISA (PhiCal)	54 (20) UC and familial polyposis coli	Differentiation between inflamed and noninflamed pouches Correlation with inflammation severity	92.5 μg/g	90%	76.50%	FC levels significantly higher in pouchitis (> 50 μg/g had higher endoscopic and histological scores) Correlation with endoscopic score (r = 0.605) and histological score (r = 0.708)
Pakarinen et al[41]	FC	ELISA (PhiCal)	32 (22) UC	Cross-sectional assessment of FC after proctocolectomy for pediatric onset UC	300 μg/g (for detection of recurrent pouchitis)	57%	92%	Higher levels of FC in patients with recurrent pouchitis, followed by those with a single episode and those without (832, 290, 71 μg/g respectively, P = 0.019) Correlation with neutrophilic infiltration and overall inflammatory activity in the distal ileum
Parsi et al[42]	FL	In-house test	60 (30) UC	Evaluate the usefulness of FL in symptomatic patients with IPAA	13 μg/mL	97%	92%	Higher levels in patients with inflammation of the pouch Not able to distinguish between pouchitis, cuffitis and CD Not able to distinguish between asymptomatic patients and those with irritable pouch syndrome Correlation with PDAI (better for endoscopic subscore)
Lim et al[43]	FL	Rapid immuno-chromatographic test	32 (11) Healthy controls and pouchitis patients	Diagnostic yield for pouchitis	/	100%	86%	Sensitive method for the non-invasive diagnosis of pouchitis
Scarpa et al[44]	FL	ELISA (IBD-scan)	32 UC	Evaluate the relationship between ileal-pouch microbiota and inflammatory parameters	/	/	/	Correlation with histological inflammation Correlation with mucosal ulcers, mucosal immune infiltration Inverse correlation with Eubacteriaceae spp., Burkholderiaceae spp and Moraxellaceae spp. counts
Yamamoto et al[45]	FC FL	ELISA (Cell Science) and Colloidal Gold Agglutinantion reagent (Auto Lf-Plus, respectively)	60 (10) UC	Evaluate the significance of consecutive monitoring of fecal markers for early diagnosis and prediction of pouchitis	56 μg/g	100%	84%	Elevation of FC and FL already 2 mo before the diagnosis of pouchitis
					50 μg/g	90%	86%	Correlation with PDAI score (correlation with endoscopic and histological subscores, but not with the clinical subscore) Correlation with response to therapy

CD: Crohn’s disease; CRP: C-reactive protein; ELISA: Enzyme-linked immunoassay; FC: Fecal calprotectin; FL: Fecal lactoferrin; PDAI: Pouch disease activity index; Sens: Sensitivity; Spec: Specificity; UC: Ulcerative colitis.