Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2019; 25(10): 1266-1277
Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1266
Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn’s disease patients
Alice Jane Foster, Matthew Smyth, Alam Lakhani, Benjamin Jung, Rollin F Brant, Kevan Jacobson
Alice Jane Foster, Matthew Smyth, Alam Lakhani, Benjamin Jung, Rollin F Brant, Kevan Jacobson, Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children’s Hospital, Vancouver, BC V6H 3V4, Canada
Alice Jane Foster, Matthew Smyth, Alam Lakhani, Benjamin Jung, Kevan Jacobson, Pediatrics, B.C. Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada
Alice Jane Foster, Matthew Smyth, Alam Lakhani, Rollin F Brant, Kevan Jacobson, Pediatrics, British Columbia children’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
Rollin F Brant, Department of Statistics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
Kevan Jacobson, Department of Cellular and Physiological Sciences, Faculty of Medicine, Vancouver, BC V6T 1Z3, Canada
Author contributions: Foster AJ and Jacobson K designed the study; Foster AJ, Smyth M, Lakani A, and Jacobson K performed the research; Foster AJ, Jung B, Brant RF and Jacobson K analyzed and interpreted the data; Foster AJ and Jacobson K wrote the manuscript with critical input from Jung B, Brant RF, Smyth M, and Lakani A.
Supported by an unrestricted grant from the Lutsky Foundation; Abbvie pharmaceuticals provided initial funding to purchase the Buhlmann ELISA kits.
Institutional review board statement: The study was reviewed and approved by the University of British Columbia Clinical Research Ethics Board and the British Columbia Children’s and Women’s Research Review Committee (H12-03533).
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kevan Jacobson, FRCP (C), MD, Doctor, Professor, Senior Scientist, Division of Gastroenterology, Hepatology and Nutrition, British Columbia children’s Hospital, 4480 Oak Street, Room K4-181, Vancouver, BC V6H 3V4, Canada. kjacobson@cw.bc.ca
Telephone: +1-6048752332 Fax: +1-6048753244
Received: December 5, 2018
Peer-review started: December 6, 2018
First decision: January 6, 2019
Revised: January 16, 2019
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: March 14, 2019

Asymptomatic children with Crohn’s disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.


In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.


In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn’s Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.


53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 μg/g (283-1758) vs 244 μg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).


Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

Keywords: Fecal calprotectin, Disease relapse, Biomarker, Crohn’s disease, Children

Core tip: It has becoming increasingly evident that many children with Crohn’s disease (CD) who are in clinical remission continue to have ongoing active intestinal inflammation. This prospective paediatric study demonstrates the utility of fecal calprotectin monitoring in asymptomatic children with CD. In this study, a significant number of children were found to have elevated levels despite clinical remission, and levels of > 250 μg/g were found to be a good predictor of clinical relapse in the subsequent 3 mo.