Issue 04

Clinical Question

Is it possible to monitor mucosal healing in ulcerative colitis (UC) without patients undergoing colonoscopy?

Editor’s Bottom Line

Yes. Both fecal calprotectin (Fcal) and the fecal immunochemical test (FIT) can be used as non-invasive surrogate markers for endoscopic mucosal healing in patients with ulcerative colitis.

Reference

Takashima S, Kato J, Hiraoka S, et al. Evaluation of mucosal healing in ulcerative colitis by fecal calprotectin vs. fecal immunochemical test. Am J Gastroenterol. 2015 Jun;110(6):873–80. https://www.ncbi.nlm.nih.gov/pubmed/25823769

Synopsis

Between 2012 and 2014, consecutive patients with UC undergoing colonoscopy to assess mucosal healing were also requested to bring two stool samples. The samples were assessed using FIT (with <100 ng/ml as a cut-off) and Fcal (using <250 µg/g as a cut-off), and results were compared against the Mayo endoscopic subscore.

A total of 92 patients with UC completed 105 colonoscopies, FIT, and Fcal measures. The sensitivity of both stool tests for predicting mucosal healing were similar (0.86 vs. 0.86), providing that mucosal healing was defined by a Mayo endoscopic subscore of either 0 or 1. For a Mayo endoscopic subscore of 0, FIT was more sensitive than Fcal (Table 1) although the areas under the receiver operating characteristics (ROC) curve were similar: 0.83 and 0.82 for FIT and Fcal, respectively.

Table 1

Details

Study Design: Prospective, single centre study
Funding: None
Allocation: n/a
Setting: Japan
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.