| Abstract: |
Background and study aim: Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are common entities. Patients with IBD oscillate between periods of active and inactive disease and may even present with concomitant functional IBS. Fecal calprotectin is a valuable marker at the very early stage of inflammatory reactions in human being. The potential strength of fecal calprotectin assessment is that it is a measure of mucosal inflammatory activity that may be detected at a level insufficient to cause any clinical symptoms, or an increase in other serum markers. We aimed to evaluate the validity and accuracy of the fecal calprotectin in differentiating patients with IBD from those with IBS and in the assessment of the severity of intestinal mucosal inflammation in patients with ulcerative colitis (UC) which may facilitate in the prognosis and follow up of patients with UC.Patients and Methods: In this work, we study 60 Patients who came to endoscopy unit with lower gastroenterological symptoms like bleeding per rectum, chronic diarrhea, and lower abdominal pain. Patients with history of infections, malignancy, gastrointestinal surgery, pregnancy, alcohol abuse or taking non-steroidal anti-inflammatory drugs were excluded from study. All patients subjected to thorough medical history, simple clinical colitis activity index was determined with a score ˃ 4 indicate active UC, complete blood picture, liver, kidney functions tests, serum markers as ESR, CRP, ANCA were done, a stool sample for FC levels determined by a highly sensitive enzyme-linked immunosorbent assay and total colonoscopy with histological examination of intestinal mucosa biopsy were done. The patients divided into 2 groups: group A: patients with ulcerative colitis, group B: patients with manifestation of irritable bowel syndrome as a control group.Results: There was a high significant difference between individuals with no pathological activity and other degree of mucosal inflammation as regard simple clinical colitis activity index, endoscopic appearance and fecal calprotectin p = 0.000, the sensitivity of fecal calprotectin in diagnosis of UC was 93.5%, while its specificity was 89.7%. Its positive predictive value for diagnosis of ulcerative colitis was 90.6%, while its negative predictive value was 92.9%. The positive predictive value of simple clinical colitis activity index for diagnosis of ulcerative colitis was 76.5%, while its negative predictive value was 80.8%. The positive predictive value of endoscopic appearance for diagnosis of ulcerative colitis was 100%, while its negative predictive value was 85.3%. There was a high significant difference and positive correlation between fecal calprotectin, score of colonic pathological activity, endoscopic appearance and simple clinical colitis activity index.Conclusion: We can conclude that fecal calprotectin is highly useful for the diagnosis and disease monitoring of patients with ulcerative colitis as it is easily, non invasive, reliable tool used as a first level test for the diagnosis and activity monitoring of UC.
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