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Managing inflammatory bowel disease (IBD) is becoming increasingly complex and personalized, considering the advent of new advanced therapies with distinct mechanisms of action. Achieving mucosal healing (MH) is a pivotal therapeutic goal in IBD management and can prevent IBD progression and reduce flares, hospitalization, surgery, intestinal damage, and colorectal cancer. Employing proactive disease and therapy assessment is essential to achieve better control of intestinal inflammation, even if subclinical, to alter the natural course of IBD. Periodic monitoring of fecal calprotectin (FC) levels and interval endoscopic evaluations are cornerstones for evaluating response/remission to advanced therapies targeting IBD, assessing MH, and detecting subclinical recurrence. Here, we comment on the article by Ishida et al Moreover, this editorial aimed to review the role of FC and endoscopic scores in predicting MH in patients with IBD. Furthermore, we intend to present some evidence on the role of these markers in future targets, such as histological and transmural healing. Additional prospective multicenter studies with a stricter MH criterion, standardized endoscopic and histopathological analyses, and virtual chromoscopy, potentially including artificial intelligence and other biomarkers, are desired.
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Biomarcadores , Fezes , Doenças Inflamatórias Intestinais , Mucosa Intestinal , Complexo Antígeno L1 Leucocitário , Humanos , Complexo Antígeno L1 Leucocitário/análise , Fezes/química , Mucosa Intestinal/patologia , Mucosa Intestinal/metabolismo , Biomarcadores/análise , Biomarcadores/metabolismo , Doenças Inflamatórias Intestinais/patologia , Doenças Inflamatórias Intestinais/metabolismo , Doenças Inflamatórias Intestinais/terapia , Índice de Gravidade de Doença , Cicatrização , Colonoscopia , Progressão da Doença , Recidiva , Endoscopia Gastrointestinal/métodosRESUMO
OBJECTIVES: To test the utility of various biomarkers as indicators of gut dysfunction in cystic fibrosis (CF) and determine whether intraindividual variations in these measures are repeatable over short intervals and whether interindividual variations correlate with clinical outcomes. STUDY DESIGN: We performed a cross-sectional, limited longitudinal study of children with CF aged 1-21 years who provided blood and stool samples at 2 or 3 visits, 2 weeks and 3 months apart, which were assayed for markers of intestinal inflammation (fecal calprotectin [fCal], lipocalin-2 [fLcn2], neopterin), and permeability (plasma lipopolysaccharide [LPS] antibodies, LPS-binding protein) by enzyme immunoassays. Control specimens were obtained from children without CF who had undergone esophagogastroduodenoscopy and had no evidence of gut inflammation. RESULTS: Twenty-six of 29 participants with CF completed the study. Sixty-nine stools (57 case/12 control) and 76 plasmas (60 case/16 control) were analyzed. LPS antibody had reliable intraindividual stability. fCal, fLcn2, and neopterin were significantly greater in CF than in control samples. fCal was negatively correlated with 3-month interval change (Δ) in weight-for-age z-score, body mass index/weight-for-length z-score, and forced expiratory volume in 1 second. fLcn2 was negatively correlated with FEV1 but not with anthropometrics. No marker correlated with Δbody mass index/weight-for-length z-score or ΔFEV1. CONCLUSIONS: fLcn2 is elevated in people with CF and might predict worse interval pulmonary function. Expanded studies are warranted to test if fLcn2 correlates with changes in additional outcomes.
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Fibrose Cística , Criança , Humanos , Fibrose Cística/complicações , Fibrose Cística/metabolismo , Estudos Longitudinais , Neopterina , Estudos Transversais , Lipopolissacarídeos , Inflamação/metabolismo , AnticorposRESUMO
Introduction: Inflammatory bowel disease is a group of pathologies that include ulcerative colitis and Crohn's disease, which have similar manifestations. Currently, the diagnosis and monitoring of this disease rely mainly on endoscopic studies. Still, this method can hardly be applied to periodic disease monitoring as it is expensive, invasive, and not readily available. Fecal calprotectin is widely known, easy to use, and affordable, and it is currently the best-characterized biomarker for this pathology. Materials and methods: The research design is a systematic diagnostic test validation literature review. A search was conducted in different databases using the QUADAS-2 checklist to evaluate the methodological quality. Results: The initial search yielded 352,843 articles published chiefly in PubMed, followed by Scopus and Science Direct. After multiple filters, 221 papers were selected and wholly reviewed. They were evaluated with inclusion and exclusion criteria, with 18 articles being chosen. Conclusions: Fecal calprotectin is a reliable surrogate marker of endoscopic activity in IBD. However, there is a lack of consensus on delimiting a cut-off point and improving applicability and diagnostic accuracy. Colonoscopy remains the gold standard in all studies.
Introducción: La enfermedad inflamatoria intestinal es un conjunto de patologías entre las que están incluidas la colitis ulcerativa y la enfermedad de Crohn, las cuales tienen presentación similar. En la actualidad, el diagnóstico y seguimiento de dicha enfermedad se basa principalmente en estudios endoscópicos, pero este método difícilmente puede aplicarse a la monitorización periódica de la enfermedad al ser costoso, invasivo y con disponibilidad limitada. La calprotectina fecal cumple con ser ampliamente disponible, fácil de usar y de precio asequible, y actualmente es el biomarcador mejor caracterizado para el uso en esta patología. Metodología: Diseño de investigación tipo revisión sistemática de la literatura de validación de prueba diagnóstica. Se realizó una búsqueda en diferentes bases de datos y para la evaluación de la calidad metodológica se empleó la lista verificación QUADAS-2. Resultados: La búsqueda inicial para la selección de los artículos arrojó un total de 352.843 artículos publicados principalmente en PubMed seguido de Scopus y Science Direct. Después de múltiples filtros se logró elegir 221 artículos, los cuales se llevaron a revisión completa. Se valoraron con criterios de inclusión y exclusión, lo que determinó la elección final de 18 artículos. Conclusiones: La calprotectina fecal es un marcador sustituto fiable de la actividad endoscópica en la EII. Se evidencia la falta de consenso para delimitar un punto de corte y mejorar la aplicabilidad y la precisión diagnóstica. La colonoscopia sigue siendo en todos los estudios el estándar de oro.
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The neglected parasitosis giardiasis is one of the most common intestinal infections worldwide, affecting mainly infants and young children. Giardia duodenalis may disturb the local microbiome, leading to intestinal ecosystem disorders, and altering different processes in the host, such as the immune response. Nevertheless, the alterations promoted by G. duodenalis on the human gut microbiome have not been thoroughly investigated. Here, we characterized the gut microbiota of G. duodenalis-infected children and determine the main alterations promoted by the parasite. To do so, fecal samples of 26 infected and four uninfected children aged 2 to 6 years old were processed for High Efficiency Microarray analysis, in order to describe their bacterial and viral profiles. Then, we quantified the total bacterial population by qPCR and assessed fecal calprotectin levels, which are closely related with gut inflammation. A total of 286 bacteria's species and 17 viruses' strains were identified. Our results revealed no statistically significant differences between G. duodenalis positive and negative groups in the taxa's phyla and families. However, bacterial species diversity was increased in children infected with G. duodenalis (p < 0.05), while the total number of bacteria was decreased (p < 0.05). Considering the virome analysis, 17 different strains were identified, 88% being bacteriophages. The correlation analysis revealed an important disruption in the balance of DNA virus and bacteria within the intestinal microbiota of Giardia-positive children. Our findings constitute the first description of the gut virome of Giardia-infected children and suggest that G. duodenalis infection exerts a modulatory effect on the gut microbiome, promoting local inflammation and altering the equilibrium of the parasite-microbiota-host triad. This highlights the importance of considering polymicrobial associations and understanding the broader context of giardiasis. Overall, our study provides new insights into the complex interactions between intestinal parasites and the microbiota, which may have implications for the development of novel therapeutic interventions in the future.
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Microbioma Gastrointestinal , Gastrópodes , Giardia lamblia , Giardíase , Microbiota , Lactente , Animais , Humanos , Criança , Pré-Escolar , Vírus de DNA , Giardia , Bactérias/genética , InflamaçãoRESUMO
Ulcerative colitis is an inflammatory disease that affects the colon, generating a crisis period associated with diarrhea and ulcerations. Stress plays a pivotal role in modulating the inflammatory response and aggravating progression. Different studies have shown that fasting reduces inflammation markers, and intermittent fasting decreases inflammatory markers such as IL-2, IL-6, and RCP. Goal: To evaluate the impact of intermittent fasting on a patient diagnosed with ulcerative colitis. A female patient underwent intermittent fasting (10/14) for eight weeks. Clinical tests were performed for blood count, RCP, biochemical profile, glycemia, and T4/TSH levels. Fecal calprotectin was determined. Clinical exams were assessed before and after intermittent fasting. Inflammation markers, such as CRP and calprotectin, were significantly reduced after eight weeks of intermittent fasting. The patient reported feeling better and was seizure-free during the following months when she continued fasting intermittently. Intermittent fasting allowed for a reduction in inflammation markers.
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Colite Ulcerativa , Feminino , Humanos , Colite Ulcerativa/complicações , Jejum Intermitente , Jejum , Inflamação , Complexo Antígeno L1 LeucocitárioRESUMO
INTRODUCTION AND AIM: Esophageal varices are one of the complications of portal hypertension in cirrhotic patients that lead to high morbidity and mortality. Our aim was to assess the fecal calprotectin (FC) level in Egyptian cirrhotic patients as a non-invasive marker for the presence of esophageal varices. MATERIALS AND METHODS: The current study included 250 participants in the period from June 2019 to November 2020, divided into three groups: group 1: 100 HCV cirrhotic patients with esophageal varices that would then be subdivided, according to the Paquet classification; group 2: 100 HCV cirrhotic patients without esophageal varices; group 3: 50 normal age and sex-matched healthy subjects as the control group. Patients with other causes of abnormal calprotectin results were excluded. RESULTS: The comparison of FC in the three study groups revealed a statistically significant difference, with FC levels higher in groups 1 and 2 (mean 66.4±10.41 and 48.4±10.92, respectively). There was a significant difference in FC levels between the subgroups, subdivided according to the Paquet classification (P=.001). FC levels were higher in the grade III and IV subgroups. FC in the diagnosis of HCV cirrhotic patients with esophageal varices showed the best performance when the cut-off value was >55; AUC was 0.918, with 92% sensitivity, 95% specificity, and 93% accuracy. CONCLUSION: FC levels serve as a screening tool for esophageal varices. FC was higher in cirrhotic patients with esophageal varices, especially in the grade III and IV subgroups, according to the Paquet classification.
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AIM: Microscopic bowel inflammation is present in up to 60% of all patients with spondyloarthritis (SpA) and appears to be associated with more severe joint disease and a higher risk of developing inflammatory bowel disease (IBD). This study aimed to determine the utility of fecal calprotectin (fCAL) in evaluating endoscopic and histological bowel inflammation in SpA patients. METHODS: Ileocolonoscopies with biopsies and fCAL measurements were performed in 65 patients with SpA. RESULTS: In 47 (72.3%) patients, the fCAL levels were higher than 50 µg/g, whereas in 20 (30.7%), these levels were greater than 250 µg/g. A total of 38 (58.5%) patients presented with microscopic bowel inflammation, and 13 (20%) presented with signs of endoscopic inflammation. fCAL levels were significantly higher in patients with microscopic bowel inflammation than in those without inflammatory findings (P < .001); additionally, these levels were slightly higher in patients with endoscopic signs of bowel inflammation (P = .053). A fCAL cutoff value of 96 µg/g predicted histological bowel inflammation with 73% sensitivity and 67% specificity. No statistically significant difference was observed in the fCAL levels between patients who had been treated or not treated with nonsteroidal anti-inflammatory drugs (NSAIDs). CONCLUSION: Our findings confirm a high prevalence of microscopic bowel inflammation in SpA patients, regardless of the use of NSAIDs. The evaluation of fCAL levels proved to be useful in the identification of microscopic inflammation and could help in the more judicious indication of ileocolonoscopy. These results support the use of fCAL for the evaluation of microscopic bowel inflammation in SpA patients.
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Doenças Inflamatórias Intestinais , Espondilartrite , Anti-Inflamatórios não Esteroides/uso terapêutico , Biomarcadores/análise , Colonoscopia , Fezes/química , Humanos , Inflamação/diagnóstico , Inflamação/tratamento farmacológico , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Complexo Antígeno L1 Leucocitário , Espondilartrite/diagnóstico , Espondilartrite/tratamento farmacológicoRESUMO
Background: Organic colonic manifestation may be difficult to be differentiated from functional one. Inflammatory bowel disease (IBD) is a common chronic inflammatory and destructive disease of the bowel wall. Chronic inflammation is associated with ulcerations, strictures, perforations, and it is a risk factor for dysplasia and cancer. To reduce these long-standing complications, IBD patients are in a continuous need for early diagnosis1. Markers, such as erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP), fecal calprotectin (FC) have been widely used as noninvasive parameters for IBD monitoring. We aimed, in this current study, to evaluate the value of fecal calprotectin and other noninvasive biomarkers in predicting abnormal histologic findings in patients undergoing colonoscopy.in addition to determine the cutoff value which predict IBD2. Methods: The present prospective study included 160 patients with complaint of colicky abdominal pain with frequent diarrhea associated with mucous and infrequent bleeding per rectum for more than 6 months. They presented partial improvement with medication and recurrence once stopping the treatment These patients had been recently diagnosed with IBD at many primary healthcare centers covering the areas of the Kafrelsheikh and Zagazik governorate in the North of Egyptian Nile delta. After complete history, clinical examination, and laboratory investigation, they were referred to the IBD clinic at Kafrelsheikh University Hospital for assessment and ileocolonoscopy with biopsies. Results: There was a wide spectrum of age of the studied patients, with mean age 40.12±7.88 (minimum 18 and maximum 56 years). Regarding gender, males represented 87.5% of the studied patients. Forty percent of the patients with colonic manifestation were smokers, 57% preferred a spicy diet, and the majority had low educational level (77.5%). Forty percent had obvious blood in stool, 55% had occult blood, and raised ESR CRP occurred in 32.5% and 50%, respectively. Fecal calprotectin cutoff was>159, with sensitivity 92.8% and specificity 97.5%. Conclusions: Biomarkers (FC, ESR, CRP) can be used as noninvasive parameters for the early diagnosis and prediction of organic colonic disease. Fecal calprotectin in the IBD group revealed significant area under the curve (AUC) values and cutoff> 159, with sensitivity 92.8% and specificity 97.5%. (AU)
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Biomarcadores/sangue , Doenças Inflamatórias Intestinais/diagnóstico , Complexo Antígeno L1 Leucocitário/sangue , Perfil de Saúde , Sedimentação Sanguínea , Proteína C-Reativa , Dor AbdominalRESUMO
ABSTRACT BACKGROUND: Gastritis consists of inflammation of the gastric mucosa and is one of the main causes of dyspeptic symptoms in children. OBJECTIVE: To investigate the presence of inflammation by evaluating fecal calprotectin (FC) in children diagnosed with chronic gastritis. DESIGN AND SETTING: Descriptive study in Pediatric Gastroenterology Department of Ondokuz Mayis University Hospital in Turkey. METHODS: Between January 2016 and July 2018, FC levels were compared retrospectively in children with chronic gastritis (histopathology-based diagnosis), patients with inflammatory bowel disease (IBD) and healthy children. RESULTS: A total of 67 chronic gastritis patients (61.2% girls) with a mean age of 13.09 ± 3.5 years were evaluated. The mean FC levels were 153.4 μg/g in the chronic gastritis group, 589.7 μg/g in the IBD group and 43.8 μg/g in the healthy group. These levels were higher in chronic gastritis patients than in healthy individuals (P = 0.001) and higher in IBD patients than in the other two groups (P < 0.001). The FC level in the patients with chronic active gastritis (156.3 μg/g) was higher than in those with chronic inactive gastritis (150.95 μg/g) (P = 0.011). Among the patients with chronic active gastritis, the FC level was significantly higher in Helicobacter pylori-positive individuals than in negative individuals (P = 0.031). CONCLUSION: We confirmed the association between increased FC and chronic gastritis. Elevated FC levels may be seen in patients with chronic active gastritis. In order to be able to use FC as a screening tool for chronic gastritis, further studies in a larger study group are needed.
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Humanos , Masculino , Feminino , Criança , Adolescente , Doenças Inflamatórias Intestinais , Gastrite/diagnóstico , Biomarcadores , Estudos Retrospectivos , Complexo Antígeno L1 Leucocitário , FezesRESUMO
Irritable bowel syndrome and inflammatory bowel disease differ in their natural evolution, etiopathogenesis, diagnostic criteria, and therapeutic approach. However, recent evidence has suggested some similarities in mechanisms underlying symptom development and progression. There is a relevant role for alterations in the microbiome-brain-gut axis in both diseases. The presence of irritable bowel syndrome symptoms in patients with quiescent inflammatory bowel disease is common in clinical practice. To determine the cause of irritable bowel syndrome symptoms in patients with quiescent inflammatory bowel disease is a clinical challenge. This review aims to illustrate possible causes and solutions for these patients.
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Doenças Inflamatórias Intestinais , Síndrome do Intestino Irritável , Microbiota , Fezes , Humanos , Doenças Inflamatórias Intestinais/complicações , Síndrome do Intestino Irritável/complicaçõesRESUMO
OBJECTIVES: To investigate the relationships between dietary intake and fecal concentrations of milk fat globule-epidermal growth factor 8 (MFG-E8), and between fecal concentrations of MFG-E8 and markers of intestinal inflammation in infants born preterm. STUDY DESIGN: Fecal samples were collected daily and enteral feedings were sampled weekly. MFG-E8 in enteral feedings and feces, and cytokine concentrations in feces were quantified by enzyme-linked immunosorbent assay. RESULTS: Milk MFG-E8 concentrations were significantly greater in unfortified mother's own milk (MOM) and MOM with human milk fortifier than either donor human milk or preterm formula. MFG-E8 concentrations in fecal samples were positively correlated with MFG-E8 concentrations in respective milks. High MFG-E8 exposure (≥60 mL/kg/day of feedings that include MOM or MOM with human milk fortifier) was associated with lower concentrations of proinflammatory cytokines (interleukin-8, tumor necrosis factor-α, and monocyte chemoattractant protein-1) and higher concentrations of the anti-inflammatory cytokine interleukin-4 in feces, compared with low MFG-E8 exposure. CONCLUSIONS: Infants born preterm who were fed MOM had greater concentrations of MFG-E8 and lower concentrations of proinflammatory cytokines in fecal samples than other diets or no feedings. These data further support the protective role of MOM, possibly because of MFG-E8, against intestinal inflammation.
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Antígenos de Superfície/metabolismo , Mucosa Intestinal/metabolismo , Proteínas do Leite/metabolismo , Leite Humano/metabolismo , Ensaio de Imunoadsorção Enzimática , Fezes , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Recém-Nascido Prematuro , Mães , Projetos PilotoRESUMO
La calprotectina fecal se ha afianzado en los últimos años como un marcador útil de las patologías gastrointestinales. El objetivo de este estudio fue determinar los niveles de calprotectina fecal (CPF), interleuquina-6 (IL-6) y proteína C reactiva (PCR) en tres grupos de pacientes: con diagnóstico de novo de enfermedad celíaca, con diagnóstico previo y dieta libre de gluten (DLG) y un grupo control. Se colectaron muestras de 79 pacientes entre 18 y 65 años. A todos se les determinó CPF, IL-6 y PCR como marcadores de inflamación y anticuerpos anti-transglutaminasa IgA y anti-gliadinas desaminadas IgA e IgG como marcadores serológicos. Se encontraron valores significativamente incrementados de PCR en el grupo de novo (124,06 μg/g) comparados con el grupo con DLG (23,61 μg/g) y el grupo control (16,91 μg/g) respectivamente. No se encontraron diferencias entre el grupo con DLG y el negativo (control). Idéntico comportamiento se observó para IL-6 con valores en el grupo de novo de 2,39 μg/dL, 1,74 μg/dL en el grupo con DLG y 1,41 μg/dL en el control negativo. No se encontraron diferencias significativas en el análisis de resultados de PCR. Se encontró una excelente sensibilidad (98,0%) y especificidad (96,6%) en la capacidad de la CPF para diferenciar valores de anti-transglutaminasa IgA superiores o inferiores al punto de corte cuando se estimó el índice de Youden. Se podría considerar a la CPF como un posible marcador sensible para indicar inflamación intestinal de manera no invasiva en la enfermedad celíaca.
The determination of fecal calprotectin has been strengthened in recent years as a useful marker of gastrointestinal pathologies. The objective of this study was to determine the levels of fecal calprotectin (FCP), interleukin-6 (IL-6) and C-reactive protein (CRP) in three groups of patients: with de novo diagnosis of celiac disease, with previous diagnosis and gluten-free diet (GFD) and a control group. Samples were collected from 79 patients between 18 and 65 years old. In all cases, FCP, IL-6 and RCP were determined as markers of inflammation and anti-transglutaminase IgA and deaminated anti-gliadin IgA and IgG antibodies as serological markers. Significantly more increased FCP values were found in the de novo group (124.06 μg/g) than in the group with DLG (23.61 μg/g) and the control group (16.91 μg/g). No differences were found between the group with GFD and the negative. The same trend was observed for IL-6 with values in the de novo group of 2.39 μg/dL, 1.74 μg/dL in the group with gluten free diet and 1.41 μg/dL in the negative control. No significant differences were found in the analysis of RCP results. Excellent sensitivity (98.0%) and specificity (96.6%) were found in the capability of the FCP to differentiate anti-transglutaminase IgA values higher or lower than the cut-off point when the Youden index was estimated. The FCP could be considered as a possible sensitive marker to indicate intestinal inflammation in a non-invasive manner in celiac disease.
A calprotectina fecal se consolidou nos ultimos anos como um marcador util das patologias gastrointestinais. O objetivo deste estudo foi determinar os niveis de calprotectina fecal (CPF), interleucina-6 (IL-6) e proteina C-reativa (PCR) em tres grupos de pacientes; com diagnostico de novo de doenca celiaca, com diagnostico previo e dieta livre de gluten (DLG) e um grupo controle. Foram coletadas amostras de 79 pacientes entre 18 e 65 anos. Em todos os casos CPF, IL-6 e PCR foram determinadas como marcadores de inflamacao e anticorpos anti-transglutaminase IgA e anti-gliadinas desaminadas IgA e IgG como marcadores sorologicos. Valores significantemente mais altos de PCR foram detectados no grupo de novo (124,06 μg/g) comparados com o grupo com DLG (23,61 μg/g) e o grupo controle (16,91 μg/g) respectivamente. Nao foram encontradas diferencas entre o grupo com DLG e o negativo (controle). O mesmo comportamento foi observado para IL-6 com valores no grupo de novo de 2,39 μg/dL, 1,74 μg/dL no grupo com DLG e 1,41 μg/dL no controle negativo. Na analise de resultados da PCR nao foram encontradas diferencas significativas. Foram detectadas uma sensibilidade excelente (98,0%) e especificidade (96,6%) na habilidade da CPF para diferenciar valores de anti-transglutaminase IgA superiores ou inferiores ao ponto de corte quando o indice de Youden foi estimado. Poderia ser considerada a CPF como um possivel marcador sensivel para identificar inflamacao intestinal de forma nao invasiva na doenca celiaca.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Patologia , Dieta Livre de Glúten , Anticorpos , Imunoglobulina A , Imunoglobulina G , Doença Celíaca , Interleucina-6 , Complexo Antígeno L1 Leucocitário , DietaRESUMO
OBJECTIVE: To investigate the additional value of blood parameters (hemoglobin, C-reactive protein, erythrocyte sedimentation rate) to anti-tissue transglutaminase (anti-tTG), fecal calprotectin, and Giardia lamblia when discriminating a functional from an organic cause in the clinical evaluation of children with chronic abdominal pain. STUDY DESIGN: This retrospective cohort study included patients (4-18 years of age) with abdominal pain for >2 months. Data on hemoglobin, C-reactive protein, erythrocyte sedimentation rate, anti-tTG, fecal calprotectin, alarm symptoms, and diagnosis were collected. RESULTS: We identified 853 patients, of whom 102 (12%) had an organic disorder. Sensitivity and the area under the curve of strategy 1 (fecal calprotectin, anti-tTG, G lamblia, blood parameters) were 90% (95% CI, 83-95) and 0.87 (95% CI, 0.81-0.93), respectively, compared with 88% (95% CI, 81-93) and 0.85 (95% CI, 0.79-0.91), respectively, for strategy 2 (fecal calprotectin, anti-tTG, G lamblia) (P = NS). In the presence of ≥1 alarm symptoms, the sensitivity of strategies 1 and 2 was 92% (95% CI, 83-96) and 92% (95% CI, 83-96), and the areas under the curve were 0.93 (95% CI, 0.89-0.98) and 0.90 (95% CI, 0.84-0.97) (P = NS). CONCLUSIONS: To distinguish between a functional and an organic cause for chronic abdominal pain, hemoglobin, C-reactive protein, and erythrocyte sedimentation rate can be left out from the clinical evaluation as they might have no additional diagnostic yield. However, caution should be taken not to miss extraintestinal infections (2%).
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Dor Abdominal/sangue , Gastroenteropatias/diagnóstico , Complexo Antígeno L1 Leucocitário/análise , Dor Abdominal/etiologia , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Fezes/química , Feminino , Giardia lamblia/isolamento & purificação , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Background: Fecal calprotectin (FC) can be a valuable tool to optimize health care for patients with inflammatory bowel disease (IBD). The objective of this observational study was to determine the level of knowledge of the FC test in Mexican patients with IBD. Methods: A self-report questionnaire was distributed via Facebook to patients with IBD. The survey consisted of 15 questions in two categories: the first category assessed knowledge of IBD diagnosis, and the second category assessed knowledge of the FC test. Results: In total, 460 patients with IBD participated, of which 83.9% (386) had ulcerative colitis (UC) and 16.0% (74) had Crohn's disease (CD). Regarding IBD diagnosis, 41.9% of participants stated that they did not know of a non-invasive test for fecal matter to identify inflammation of the colon. Regarding the FC test, 57.5% (UC) and 58.1% (CD) stated that they did not know about the test. Additionally, 65.8% (UC) and 51.3% (CD) of participants stated that they had never received the FC test and 82.6% (UC) and 77.0% (CD) recognized that the FC test was difficult to access in their medical practice. Furthermore, 66% (UC) and 52.7% (CD) of participants noted that their specialist doctor had never suggested the FC test to them, yet 89.1% (UC) and 87.8% (CD) stated that they would prefer FC analysis for their IBD follow-up assessments. Conclusions: There is little knowledge of the FC biomarker among Mexican patients with IBD. This suggests the need for greater dissemination of its use and scope as a biomarker in IBD.
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OBJECTIVES: Little research exists documenting levels of intestinal inflammation among indigenous populations where exposure to macroparasites, like soil-transmitted helminths (STHs), is common. Reduced STH exposure is hypothesized to contribute to increased prevalence of elevated intestinal inflammation in wealthy nations, likely due to coevolutionary histories between STHs and human immune systems that favored anti-inflammatory pathways. Here, we document levels of intestinal inflammation and test associations with STH infection among the Shuar of Ecuador, an indigenous population undergoing socioeconomic/lifestyle changes that influence their hygienic environment. We predict that fecal calprotectin (FC; a measure of intestinal inflammation) will be lower in STH infected individuals and that FC will be negatively associated with infection intensity. METHODS: Stool samples to analyze FC levels and STH infection were collected from 69 Shuar participants (ages 5-75 years). Children (<15 years) and adults (15+ years) were analyzed separately to understand the role of exposure in immune system development and the intestinal inflammatory response. RESULTS: Two species of STH were present: Ascaris lumbricoides and Trichuris trichiura. The relationships between infection and intestinal inflammation were age- and species-specific. While no significant relationships were found among adults, children who were singly infected with T. trichiura had lower FC levels than uninfected children. Infection intensity was not significantly associated with FC in children or adults. CONCLUSIONS: These preliminary results provide limited support for our hypotheses, documenting tentative age- and species-specific associations between FC and infection status. Findings may point to the importance of species-specific STH exposure during immune system development.
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Helmintíase/complicações , Helmintíase/epidemiologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Adolescente , Adulto , Idoso , Ascaríase/complicações , Ascaríase/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Equador , Fezes/química , Fezes/parasitologia , Feminino , Humanos , Complexo Antígeno L1 Leucocitário/análise , Masculino , Pessoa de Meia-Idade , Tricuríase/complicações , Tricuríase/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Gut inflammation is closely related to spondyloarthritis (SpA) pathophysiology. Fecal calprotectin has been used to measure the degree of gut inflammation. The phenotype of SpA may change according to studied population. AIM: To study the fecal calprotectin levels in a sample of SpA in Brazilian patients and its relationship with epidemiological, clinical and treatment variables as well as with the macro and microscopic degree of gut inflammation. METHODS: Eighty five SpA patients were studied for epidemiological and clinical features, functional and inflammatory indexes and fecal calprotectin levels measured using a ELISA kit. Colonoscopy with intestinal biopsies were performed in 39 of them. At time of colonoscopy a second calprotectin level was done after suspension of at least 3 weeks of used anti-inflammatory nonsteroidal drugs (NSAIDs). RESULTS: Fecal calprotectin levels were higher in Ankylosing Spondylitis (AS) patients (p <0.0001) and in those with axial involvement (p = 0.002). No relationship was found with SpA inflammatory and functional parameters (all p = ns). After suspension of NSAIDs, a drop in fecal calprotectin levels was observed (from median levels of 215.0-76.0 µg/g; p = 0.01). In the colonoscopy, 33.3% had macroscopic signs of inflammation and these patients had higher calprotectin (p = 0.009) than others. Microscopic examination showed that all patients had lymphoplasmacytic infiltrate and eosinophilic infiltrate; epithelial erosion was present in 27.2%. CONCLUSIONS: Patients with ankylosing spondylitis and axial forms of diseases have higher fecal calprotectin levels. Patients with all types of SpA have microscopic inflammatory changes in the gut.
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Anti-Inflamatórios não Esteroides/uso terapêutico , Intestinos/patologia , Complexo Antígeno L1 Leucocitário/análise , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/patologia , Biomarcadores/análise , Brasil/epidemiologia , Colonoscopia , Ensaio de Imunoadsorção Enzimática , Fezes/química , Feminino , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/epidemiologiaRESUMO
OBJETIVO: determinar la sensibilidad y especificidad de la calprotectina fecal (CPF) y la prueba de sangre oculta en heces (SOH) para el diagnóstico de patología orgánica de colon. MÉTODOS: se realizó un estudio observacional que, incluyó de manera intencionada, 246 pacientes de ambos sexos atendidos en el Instituto Gastroenterológico Boliviano Japonés de Cochabamba, por dolor abdominal, diarrea crónica y pérdida de peso. Se les realizó laboratorios de calprotectina fecal y sangre oculta en heces, además de colonoscopia como estudio de control. RESULTADOS: se determinó que la calprotectina fecal tiene una sensibilidad de 86 %, y especificidad de 98 %, con una asociación de 0,54 y relación de 0,75 según los coeficientes de Pearson y Spearman respectivamente, en relación con la colonoscopía y el diagnóstico de patología orgánica de colon. La prueba de sangre oculta en heces presentó una sensibilidad de 79% pero una especificidad de 58%, la asociación y relación con el estudio de control fue mínima: 0,21 y 0,22 según los coeficientes de Pearson y Spearman. CONCLUSIONES: los resultados muestran que la calprotectina fecal presenta alta sensibilidad y especificidad para el diagnóstico de patología orgánica de colon. Los valores más altos se relacionaron con mayor lesión en la mucosa colónica.
OBJECTIVE: to determine the sensitivity and specificity of fecal calprotectin and fecal occult blood test (FOBT) for the diagnosis of organic colon pathology. METHODS: an observational study was made, which intentionally included 246 patients of both sexes seen at the Japanese Bolivian Gastroenterological Institute of Cochabamba, due to abdominal pain, chronic diarrhea and weight loss. We performed fecal calprotectin and fecal occult blood laboratories, as well as colonoscopy as a control study. RESULTS: it was determined that the fecal calprotectin has a sensitivity of 86%, and specificity of 98%, with an association of 0,54 and a ratio of 0,75 according to the Pearson and Spearman coefficients respectively, in relation to colonoscopy and the diagnosis of organic pathology of colon. The fecal occult blood test showed a sensitivity of 79% but a specificity of 58%, according to the association and relationship with the control minimum of 0,21 and 0,22 according to the Pearson and Spearman coefficients. CONCLUSIONS: The results show that fecal calprotectin presents high sensitivity and specificity for the diagnosis of organic colon pathology. Higher values were associated with greater lesion in the colonic mucosa.
Assuntos
Humanos , Hemocultura/métodos , Colonoscopia/instrumentação , Diagnóstico , FezesRESUMO
OBJECTIVES: To evaluate crying time, retinoid-related orphan receptor-γ (RORγ) and forkhead box P3 (FOXP3) messenger RNA levels (transcription factors that can modulate T cell responses to gut microbes), and to investigate gut microbiota and fecal calprotectin in infants treated with Lactobacillus reuteri for infantile colic. STUDY DESIGN: A double-blind, placebo-controlled randomized trial was conducted in primary care in Torino from August 1, 2015 to September 30, 2016. Patients suffering from infantile colic were randomly assigned to receive daily oral L reuteri (1 × 108 colony forming unit) or placebo for 1 month. Daily crying times were recorded in a structured diary. FOXP3 and RORγ messenger RNA in the peripheral blood was assessed with real-time TaqMan reverse transcription polymerase chain reaction. Gut microbiota and fecal calprotectin were evaluated. RESULTS: After infants with colic were supplemented with L reuteri DSM 17938 for 30 days, crying times were significantly shorter among infants with colic in the probiotic group compared with infants in the placebo group (74.67 ± 25.04 [IQR = 79] minutes /day vs 147.85 [IQR = 135] minutes /day [P = .001]). The FOXP3 concentration increased significantly (P = .009), resulting in decreased RORγ/FOXP3 ratios: 0.61 (IQR = 0.60) at day 0 and 0.48 (IQR = 0.28) at day 30 (P = .028). Furthermore, the probiotic increased the percentage of Lactobacillus (P = .049) and decreased fecal calprotectin (P = .0001). CONCLUSIONS: Infants with colic treated with L reuteri for 30 days had a significantly decreased crying time and an increased FOXP3 concentration, resulting in a decreased RORγ/FOXP3 ratio. The treatment reduced fecal calprotectin. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00893711.
Assuntos
Cólica/terapia , Choro , Fatores de Transcrição Forkhead/sangue , Limosilactobacillus reuteri , Membro 3 do Grupo F da Subfamília 1 de Receptores Nucleares/sangue , Probióticos/uso terapêutico , Biomarcadores/metabolismo , Estudos de Casos e Controles , Cólica/metabolismo , Cólica/microbiologia , Cólica/psicologia , Método Duplo-Cego , Fezes/química , Fezes/microbiologia , Feminino , Seguimentos , Microbioma Gastrointestinal , Humanos , Lactente , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Resultado do TratamentoRESUMO
AIM: To evaluate intra- and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin (FC) levels. METHODS: Our institutional computed tomography enterography (CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease (IBD) and FC collected < 4 mo after CTE without any change in clinical treatment or surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization (small bowel, colonic, both, or no disease detected); type of IBD (inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease (present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who re-evaluated the CTEs ≥ 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 µg/g. RESULTS: Forty-four patients with IBD (38 with Crohn's disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD (κ = 0.540), type of disease (κ = 0.410) and the presence of active signs in CTE (κ = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The κ values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24 (85.7%) of 28 patients who were classified with active disease had elevated FC, and six (37.5%) of 16 patients without inflammatory activity in CTE had elevated FC (P = 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant (κ = 0.495, P = 0.001). CONCLUSION: We found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CTE with concurrence of high FC levels.
Assuntos
Colite Ulcerativa/diagnóstico por imagem , Colo/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Variações Dependentes do Observador , Adulto , Idoso , Fezes/química , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Complexo Antígeno L1 Leucocitário/análise , Masculino , Pessoa de Meia-Idade , Radiologistas , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Abstract Objectives: To assess the level of fecal calprotectin in preterm neonates with feeding intolerance, as well as to evaluate it as a marker of feeding intolerance and to determine a cut-off level of fecal calprotectin in feeding intolerance. Methods: Analytical, multicenter, case-control study, which was carried out in neonatal intensive care units in Egypt, in a period from August 1, 2014 to March 1, 2015 on 52 preterm neonates. Neonates were classified into two groups; a study group including 26 neonates who met inclusion criteria and a control group including 26 neonates for comparison. Results: Fecal calprotectin levels ranged from 3.9 µg/g to 971.8 µg/g, and there was a significant increase in fecal calprotectin in the study group when compared to the control group (334.3 ± 236.6 µg/g vs. 42.0 ± 38.2 µg/g, respectively) with moderate inverse significant correlation between fecal calprotectin and birth weight. Furthermore, there was moderate, significant correlation between fecal calprotectin and duration of breastfeeding range. On the other hand, there was no correlation between fecal calprotectin and post-natal age, gestational age, or volume of feeding. A cut-off at the 67.0 µg/g level, with 100.0% sensitivity and 76.9% specificity, was considered. Conclusion: Fecal calprotectin level increased significantly in neonates with feeding intolerance; it can be used to detect early cases with necrotizing enterocolitis in neonates, but this subject still needs more investigations on more patients.
Resumo Objetivos Avaliar o nível de calprotectina fecal em neonatos prematuros com intolerância alimentar, além de avaliá-lo como um indicador de intolerância alimentar e determinar um nível de corte da calprotectina fecal na intolerância alimentar. Métodos Estudo caso-controle analítico, feito em um multicentro de unidades de terapia intensiva neonatais no Egito, de 1° de agosto de 2014 a 1° de março de 2015, com 52 neonatos prematuros. Os neonatos foram classificados em dois grupos; um grupo de estudo incluindo 26 neonatos que atenderam aos critérios de inclusão e um grupo de controle incluindo 26 neonatos para comparação. Resultados Os níveis de calprotectina fecal variaram de 3,9 µg/g a 971,8 µg/g e houve um aumento significativo da calprotectina fecal no grupo de estudo quando comparado com o grupo de controle (334,3 ± 236,6 µg/g em comparação com 42,0 ± 38,2 µg/g, respectivamente) com correlação inversa, moderada e significativa entre a calprotectina fecal e o peso ao nascer. Adicionalmente, houve correlação moderada significativa entre a calprotectina fecal e a duração do intervalo de amamentação. Por outro lado, não houve correlação entre a calprotectina fecal e a idade pós-natal, a idade gestacional ou o volume de amamentação. Foi considerado um corte nos níveis de 67,0 µg/g; com sensibilidade de 100,0% e especificidade de 76,9%. Conclusão O nível de calprotectina fecal aumentou significativamente em neonatos com intolerância alimentar e podemos usá-lo para detectar casos precoces com enterocolite necrosante em neonatos, porém ainda são necessárias mais investigações em mais pacientes.’.