F ecal calprotectin and lactoferrin are sensitive markers of intestinal inflammation in IBD. They have been shown to correlate with clinical and endoscopic activity [1][2][3] and their prognostic value in detecting upcoming flares is increasingly being recognized. 4 Lamb et al investigated fecal calprotectin and lactoferrin in two Crohn's disease (CD) patient cohorts having undergone ileocecal resection. In the first cohort 13 patients were prospectively followed for 1 year with repetitive fecal sampling (in total, 155 samples), whereas in the second cohort 104 patients (median 24 months after resection) were retrospectively analyzed based on a single stool sample. Fecal measurements were compared with the Harvey-Bradshaw Index (HBI), ileocolonoscopic findings, C-reactive protein (CRP), and platelet counts.
The authors found a normalization of the fecal markers within 2 months postoperatively in cases with uncomplicated disease course. Calprotectin as well as lactoferrin correlated significantly with HBI. Both fecal markers were found elevated in a high proportion of CD patients with severe clinical activity, whereas low levels were measured in patients with clinically inactive disease. In patients with mild to moderately clinically active disease, fecal calprotectin and lactoferrin were able to identify individuals with and without recurrent inflammatory disease. The fecal markers were more accurate at predicting clinical disease activity than CRP, platelet count, or endoscopic appearance. The authors concluded that both fecal calprotectin and lactoferrin could help to identify disease recurrence in symptomatic postoperative patients.