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Vol. 43. Issue 2.
Pages 73-78 (February 2020)
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Vol. 43. Issue 2.
Pages 73-78 (February 2020)
Original article
Limitations of the determination of faecal calprotectin in patients with ulcerative colitis and inflammatory polyps
Limitaciones de la determinación de calprotectina fecal en pacientes con colitis ulcerosa y pólipos inflamatorios
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Fernando Bermejoa,b,
Corresponding author
fbermejos1@gmail.com

Corresponding author.
, Alicia Algabaa, Daniel Bonilloa, Laura Jiméneza, Antonio Guardiola-Arévaloa, María Pachecoc, Ángel Castañod, Iván Guerraa
a Servicio de Digestivo, Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
b Departamento de Medicina, Universidad Rey Juan Carlos, Madrid, Spain
c Servicio de Laboratorio, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
d Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Table 1. Faecal calprotectin determinations, and characteristics and location of inflammatory polyps in our patients.
Abstract
Introduction

Faecal calprotectin is a useful technique for detecting activity in patients with ulcerative colitis. However, there may be high levels due to factors other than the activity of ulcerative colitis. Our aim was to analyse possible false positive results of calprotectin for the activity of ulcerative colitis owing to the presence of inflammatory polyps.

Patients and methods

Retrospective, observational, descriptive study. Data was collected from patients monitored for 2 years in whom a colonoscopy had been requested within 3 months after detecting high calprotectin values (>150 μg/g) and before modifying the treatment.

Results

We reviewed 39 patients and in 5 of them, with previous diagnosis of extensive ulcerative colitis, inflammatory polyps were detected. Three patients were on treatment with mesalazine, one with azathioprine and another with infliximab. All of them were asymptomatic and the endoscopy showed no macroscopic activity (endoscopic Mayo score = 0) or histological activity. The median values for calprotectin were 422 μg/g (IQR: 298-2408) and they remained elevated in a second measurement. In 4 of the patients, the inflammatory polyps were multiple and small in size. The other patient had a polyp measuring 4 cm.

Discussion

In clinical practice we can find high faecal calprotectin levels not due to the presence of ulcerative colitis activity, but to other lesions, such as inflammatory polyps. This fact must be taken into account before carrying out relevant changes such as step-up therapy to immunosuppressive drugs or biological drugs in patients with confirmed high calprotectin levels.

Keywords:
Calprotectin
Ulcerative colitis
Inflammatory bowel disease
Inflammatory polyps
Resumen
Introducción

La calprotectina en heces es una técnica útil para detectar actividad en pacientes con colitis ulcerosa. No obstante, puede haber valores elevados debido a otros factores distintos de la actividad de la colitis ulcerosa. Nuestro objetivo fue analizar posibles resultados falsos positivos de calprotectina para la actividad de la colitis ulcerosa debidos a la presencia de pólipos inflamatorios.

Pacientes y métodos

Estudio retrospectivo, descriptivo y observacional. Se recogieron los datos de pacientes seguidos durante 2 años en los que se realizó una colonoscopia dentro de los 3 meses posteriores a detectarse valores de calprotectina elevados (>150 µg/g) antes de modificar el tratamiento.

Resultados

Se revisaron 39 pacientes y en 5 de ellos, previamente diagnosticados de colitis ulcerosa extensa, se detectaron pólipos inflamatorios. Tres pacientes tomaban mesalazina, 1 azatioprina y otro en tratamiento con infliximab. Todos ellos se encontraban asintomáticos y la endoscopia no presentaba actividad macroscópica (Mayo endoscópico = 0) ni histológica. La mediana de los valores de calprotectina fue: 422 µg/g (RIQ: 298-2408) y permanecieron elevados en una segunda determinación. En 4 de los pacientes los pólipos inflamatorios eran múltiples y de pequeño tamaño. Otro paciente presentaba un pólipo de 4 cm.

Discusión

En la práctica clínica podemos encontrar valores de calprotectina fecal elevados no debidos a la presencia de actividad de la colitis ulcerosa sino a otras lesiones como pólipos inflamatorios. Este hecho debe ser tenido en cuenta antes de llevar a cabo cambios relevantes como la subida de escalón terapéutico a inmunosupresores o biológicos en pacientes con elevación de calprotectina confirmada.

Palabras clave:
Calprotectina
Colitis ulcerosa
Enfermedad inflamatoria intestinal
Pólipos inflamatorios

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