Background & Aims

Data regarding fecal calprotectin (FC), commonly used for noninvasive monitoring in inflammatory bowel diseases, are scarce in patients with ileal pouch–anal anastomosis (IPAA). We aimed to assess the association between FC levels and pouch inflammation in patients with ulcerative colitis who underwent IPAA.

Methods

A cross-sectional study of adults with ulcerative colitis who underwent IPAA with J-pouch formation prospectively followed in a dedicated pouch clinic. Patients had clinical, endoscopic, and histologic assessments within 90 days of FC sampling. Each patient encounter was evaluated separately. Pouchitis was defined as a Pouchitis Disease Activity Score of ≥7 (maximum score: 18).

Results

Overall, 156 patients had 296 encounters that met inclusion criteria. A total of 52% of patients were male, median age at evaluation was 43 (IQR, 35–58) years, and median pouch age was 10 (interquartile range [IQR], 2.5–15) years. Median FC values were significantly lower in patients without compared with those with pouchitis (208 [IQR, 96–478] μg/g vs 550 [IQR, 250–1051] μg/g; P < .0001). Mean FC values increased among patients with higher endoscopic and histologic scores. FC performed better than C-reactive protein as a predictor of pouchitis. FC of >460 μg/g had >80% specificity for predicting significant endoscopic disease (Pouchitis Disease Activity Score endoscopic subscore ≥5), while an FC of <125 μg/g had over 80% specificity in predicting endoscopic remission.

Conclusions

FC levels are increased in patients with endoscopic and histologic inflammation of the pouch. FC may be a useful tool in the management of patients following IPAA.

中文翻译：

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粪便钙卫蛋白在储袋炎中增加，并随着更严重的内窥镜和组织学疾病而逐渐增加

背景与目标

粪便钙卫蛋白 (FC) 的数据通常用于炎症性肠病的无创监测，但在回肠储袋-肛门吻合术 (IPAA) 患者中很少见。我们旨在评估接受 IPAA 的溃疡性结肠炎患者的 FC 水平与小袋炎症之间的关联。

方法

一项针对患有溃疡性结肠炎的成人的横断面研究，在专门的造口袋诊所中前瞻性地进行了 IPAA 并形成 J 型造口袋。患者在 FC 取样后 90 天内进行了临床、内窥镜和组织学评估。每个病人的遭遇都被单独评估。贮袋炎被定义为贮袋炎疾病活动评分≥7（最高分：18）。

结果

总体而言，156 名患者有 296 次就诊符合纳入标准。共有 52% 的患者为男性，评估时的中位年龄为 43（IQR，35-58）岁，中位储袋年龄为 10（四分位距 [IQR]，2.5-15）岁。与患有储袋炎的患者相比，未患贮袋炎患者的中位 FC 值显着降低（208 [IQR, 96-478] μg/g vs 550 [IQR, 250-1051] μg/g；P < .0001）。内镜和组织学评分较高的患者的平均 FC 值增加。FC 作为储袋炎的预测指标优于 C 反应蛋白。FC > 460 μg/g 对预测显着内镜疾病的特异性> 80%（储袋炎疾病活动评分内镜子评分≥5），而FC <125 μg/g 在预测内镜缓解方面的特异性超过80%。

结论

FC 水平在袋内镜检查和组织学炎症的患者中增加。FC 可能是管理 IPAA 后患者的有用工具。