Post-operative Crohn's disease :can non-invasive faecal markers predict post-operative course of Crohn's disease

Abstract

Background: Identifying Crohn’s disease recurrence in symptomatic patients after ileocaecal resection is difficult as symptoms may reflect the effect of surgery rather than active disease. The aim of this study was to evaluate faecal concentrations of granulocyte degradation products (faecal calprotectin and faecal lactoferrin) in this post-operative setting. Methods: A post-operative cohort of 104 patients (median follow up of 24 months) provided a single stool sample. A second cohort of 13 patients was followed prospectively for 1 year with regular faecal calprotectin (FC) and faecal lactoferrin (FL) measurements. Faecal measurements were compared with symptom diaries, the Harvey Bradshaw Index (HBI), endoscopic examination, C-reactive protein (CRP) and platelet measurement. Results: Both faecal calprotectin and faecal lactoferrin correlated significantly with Harvey Bradshaw Index (r = 0.532, P< 0.001, r = 0.687, P< 0.001 respectively). Twenty eight patients with severely clinically active disease had high mean (s.e) levels of faecal calprotectin (661.1(119.1) μg/g) and faecal lactoferrin (116.6(32.2) μg/g); and forty three patients with clinically inactive disease had low levels of faecal calprotectin (70.2(27.1) μg/g) and faecal lactoferrin (5.9(2.4) μg/g). In patients with mild to moderately clinically active disease, faecal calprotectin and faecal lactoferrin identified individuals with and without recurrent inflammatory disease. In the uncomplicated course, both markers (faecal calprotectin and lactoferrin) normalized within 2 months. Faecal markers were more accurate at predicting clinical disease activity than C-reactive protein, platelet count or endoscopic appearance. Conclusion: Faecal calprotectin and faecal lactoferrin are non-invasive tests that can help to identify disease recurrence in symptomatic post-operative patients [1].