PoM No 10, 2013

Publication of the Month

October 10/13: Non-Invasive Disease Monitoring in Ulcerative Colitis Patients


Key messages:
  • Fecal Calprotectin is not only useful for the accurate discrimination between IBD and IBS but also for differentiation between active and inactive forms of IBD.
  • Fecal Calprotectin is a useful biomarker for non-invasive activity monitoring in ulcerative colitis.


Schoepfer AM, Beglinger C, Straumann A, Safroneeva E, Romero Y, Armstrong D, Schmidt C, Trummler M, Pitet V, Varicka SR.
Fecal Calprotectin More Accurately Reflects Endoscopic Activity of Ulcerative Colitis than the Lichtiger Index, C-reactive Protein, Platelets, Hemoglobin and Blood Leukocytes.
Inflamm Bowel Dis. 2013;19:332-341

Background: Management of Ulcerative Colitis (UC) requires ongoing assessment of symptoms to determine possible relapse as well as mucosal healing. However, as endoscopic investigation is invasive, time-consuming and expensive, there has been an enthusiastic search for accurate biomarkers. The Lichtiger Index (LI) looks at 8 clinical variables to score likely disease activity but it has not yet been extensively validated and its association with inflammation has not yet been evaluated in clinical studies.
This paper evaluates the correlation between endoscopic activity, LI, and several biomarkers including the relatively new Fecal Calprotectin (FC) in UC patients.

Summary: 228 UC patients underwent colonscopy and were scored clinically (LI) and endoscopically (modified Baron Score). They and 52 healthy controls also had feces and blood samples analysed for biomarkers; (C-reactive protein (crp), platelets, leukocytes, hemoglobin and FC. Endoscopic disease activity correlated best with FC (Spearman’s rank correlation coefficient r=0.821 followed by LI (r=0.682), crp (r=0.556), platelets (r=0.488), blood leukocytes (r=0.401) and hemoglobin (r=-0.388). FC was the only marker that could discriminate between different grades of endoscopic activity. At a cut-off of 58ug/g, FC had a sensitivity of 91% and a specificity of 90% to detect endoscopically active disease.

Conclusions: FC concentration strongly correlated with endoscopic severity according to the modified Baron Score. The Lichtiger Index also demonstrated a good correlation but it was not as good as that of FC.

Comment: This is a well-controlled study where the entire disease cohort underwent endoscopy to give a definitive disease activity status to which other parameters can be compared. It is also the first study to evaluate the correlation between the Lichtiger Index (also a non-invasive tool) and disease activity. The strong correlation with disease shown by fecal calprotectin suggests that it represents a useful biomarker for non-invasive monitoring of disease activity in ulcerative colitis patients


As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.