Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2024; 30(24): 3022-3035
Published online Jun 28, 2024. doi: 10.3748/wjg.v30.i24.3022
Fecal calprotectin and endoscopic scores: The cornerstones in clinical practice for evaluating mucosal healing in inflammatory bowel disease
Marcia Henriques de Magalhães Costa, Ligia Yukie Sassaki, Júlio Maria Fonseca Chebli
Marcia Henriques de Magalhães Costa, Department of Clinical Medicine, Fluminense Federal University, Rio de Janeiro 24210-200, Brazil
Ligia Yukie Sassaki, Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu 18618-686, São Paulo, Brazil
Júlio Maria Fonseca Chebli, Division of Gastroenterology, Department of Medicine, University Hospital of The Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora 36036-247, Minas Gerais, Brazil
Author contributions: Costa MHM, Sassaki LY, and Chebli JMF contributed to the conception and design of the study, acquisition of data, drafting of the article, and making critical revisions related to the important intellectual content of the manuscript; All of the authors approved the final version of the article to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Júlio Maria Fonseca Chebli, MD, PhD, Full Professor, Division of Gastroenterology, Department of Medicine, University Hospital of The Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Rua Maria Jose Leal, 296, Juiz de Fora 36036-247, Minas Gerais, Brazil. julio.chebli@medicina.ufjf.br
Received: March 3, 2024
Revised: May 1, 2024
Accepted: May 27, 2024
Published online: June 28, 2024
Processing time: 113 Days and 14.6 Hours
Abstract

Managing inflammatory bowel disease (IBD) is becoming increasingly complex and personalized, considering the advent of new advanced therapies with distinct mechanisms of action. Achieving mucosal healing (MH) is a pivotal therapeutic goal in IBD management and can prevent IBD progression and reduce flares, hospitalization, surgery, intestinal damage, and colorectal cancer. Employing proactive disease and therapy assessment is essential to achieve better control of intestinal inflammation, even if subclinical, to alter the natural course of IBD. Periodic monitoring of fecal calprotectin (FC) levels and interval endoscopic evaluations are cornerstones for evaluating response/remission to advanced therapies targeting IBD, assessing MH, and detecting subclinical recurrence. Here, we comment on the article by Ishida et al Moreover, this editorial aimed to review the role of FC and endoscopic scores in predicting MH in patients with IBD. Furthermore, we intend to present some evidence on the role of these markers in future targets, such as histological and transmural healing. Additional prospective multicenter studies with a stricter MH criterion, standardized endoscopic and histopathological analyses, and virtual chromoscopy, potentially including artificial intelligence and other biomarkers, are desired.

Keywords: Fecal calprotectin; Endoscopic scores; Mucosal healing; Histological healing; Ulcerative colitis; Inflammatory bowel diseases

Core Tip: Mucosal healing (MH) is a pivotal goal in inflammatory bowel disease (IBD) management and can prevent IBD relapse. However, assessing MH is challenging due to the poor correlation between symptoms and intestinal inflammation. Fecal calprotectin (FC) levels and interval endoscopic evaluation are cornerstones for achieving this goal. The editorial updates the best predictor tools of IBD relapse in 12 mo concerning FC and endoscopic scores (ESs). In the retrospective single-center study, all three ESs and FC were useful in predicting ulcerative colitis relapse, suggesting the Ulcerative Colitis Endoscopic Index of Severity as the preferred choice for combining feasibility and accuracy.