Association Between Fecal Calprotectin Levels and Small-bowel Inflammation Score in Capsule Endoscopy: A Multicenter Retrospective Study

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BACKGROUND: Accurate inflammation reporting in capsule endoscopy (CE) is important for diagnosis and monitoring of treatment of inflammatory bowel disease (IBD). Fecal calprotectin (FC) is a highly specific biomarker of gut inflammation. Lewis score (LS) was developed to standardize quantification of inflammation in small-bowel (SB) CE images.

GOALS: Multicenter retrospective study aiming to investigate correlation between LS and FC in a large group of patients undergoing CE for suspected or known small-bowel IBD, and to develop a model for prediction of CE results (LS) based on FC levels.

STUDY: Five academic centers and a district general hospital offering CE in UK, Finland, Sweden, Canada, and Israel. In total, 333 patients were recruited. They had small-bowel CE and FC done within 3 months.

RESULTS: Overall, correlation between FC and LS was weak (r s: 0.232, P < 0.001). When two clinically significant FC thresholds (100 and 250 μg/g) were examined, the r s between FC and LS was 0.247 (weak) and 0.337 (moderate), respectively (P = 0.307). For clinically significant (LS ≥ 135) or negative (LS < 135) for SB inflammation, ROC curves gave an optimum cutoff point of FC 76 μg/g with sensitivity 0.59 and specificity 0.41.

LIMITATIONS: Retrospective design.

CONCLUSIONS: LS appears to show low correlation with FC as well as other serology markers of inflammation. FC does not appear to be a reliable biomarker for significant small-bowel inflammation. Nevertheless, FC level ≥ 76 μg/g may be associated with appreciable visual inflammation on small-bowel CE in patients with negative prior diagnostic workup.


  • Anastasios Koulaouzidis
  • Taina Sipponen
  • Artur Nemeth
  • Richard Makins
  • Uri Kopylov
  • Moshe Nadler
  • Andry Giannakou
  • Diana E Yung
  • Gabriele Wurm Johansson
  • Leonidas Bartzis
  • Henrik Thorlacius
  • Ernest G Seidman
  • Rami Eliakim
  • John N Plevris
  • Ervin Toth
Enheter & grupper
Externa organisationer
  • Royal Infirmary of Edinburgh
  • University of Helsinki
  • Gloucestershire Hospitals NHS Foundation Trust
  • McGill University
  • Tel-Aviv University
  • Open University of Cyprus

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Gastroenterologi
Sidor (från-till)2033–2040
TidskriftDigestive Diseases and Sciences
Tidigt onlinedatum2016 mar 23
StatusPublished - 2016 jul
Peer review utfördJa