Measurement of Fecal Calprotectin Improves Monitoring and Detection of Recurrence of XXXX After Surgery.

@entity1 @entity30 @entity1851
BACKGROUND _ AIMS: @entity30 ( @entity30 ) usually recurs after intestinal resection; postoperative endoscopic monitoring and tailored treatment can reduce the chance of recurrence. We investigated whether monitoring levels of fecal calprotectin (FC) can substitute for endoscopic analysis of the mucosa. METHODS: We analyzed data collected from 135 @entity1 in a prospective, randomized, controlled trial, performed at 17 hospitals in Australia and 1 hospital in New Zealand, that assessed the ability of endoscopic evaluations and step-up treatment to prevent @entity30 recurrence after surgery. Levels of FC, serum levels of @entity1851 ( @entity1851 ), and @entity30 activity index (CDAI) scores were measured before surgery and then at 6, 12, and 18 months after resection of all macroscopic @entity30 . Ileocolonoscopies were performed at 6 months after surgery in 90 @entity1 and at 18 months after surgery in all @entity1 . RESULTS: Levels of FC were measured in 319 samples from 135 @entity1 . The median FC level decreased from 1347  g/g before surgery to 166  g/g at 6 months after surgery, but was higher in @entity1 with disease recurrence (based on endoscopic analysis; Rutgeerts score, >= i2) than in @entity1 in remission (275 vs 72  g/g, respectively; P < .001). Combined 6- and 18-month levels of FC correlated with the presence (r  = 0.42; P < .001) and severity (r  = 0.44; P < .001) of @entity30 recurrence, but the @entity1851 level and CDAI score did not. Levels of FC greater than 100  g/g indicated endoscopic recurrence with 89% sensitivity and 58% specificity, and a negative predictive value (NPV) of 91%; this means that colonoscopy could have been avoided in 47% of @entity1 . Six months after surgery, FC levels less than 51  g/g in @entity1 in endoscopic remission predicted maintenance of remission (NPV, 79%). In @entity1 with endoscopic recurrence at 6 months who stepped-up treatment, FC levels decreased from 324  g/g at 6 months to 180  g/g at 12 months and 109  g/g at 18 months. CONCLUSIONS: In this analysis of data from a prospective clinical trial, FC measurement has sufficient sensitivity and NPV values to monitor for @entity30 recurrence after intestinal resection. Its predictive value might be used to identify @entity1 most likely to relapse. After treatment for recurrence, the FC level can be used to monitor response to treatment. It predicts which @entity1 will have disease recurrence with greater accuracy than @entity1851 level or CDAI score.
