LAUSR

An accurate and non-invasive surrogate marker of inflammation is needed for managing patients after Ileal pouch-anal anastomosis (IPAA). In this study, we evaluate the performance of fecal calprotectin (FC) in patients with ulcerative colitis (UC) who underwent IPAA and were assessed with clinical, endoscopic, and histologic examination of the pouch. Medical records of patients who underwent IPAA with J-pouch formation registered in a prospectively collected database at the Tel Aviv Sourasky Medical Center, Israel, were evaluated. Clinical, endoscopic, histologic, and laboratory data were extracted. Each pouch evaluation was regarded separately. Pouchitis was defined as a Pouchitis Disease Activity Score (PDAI) of ≥7 (maximum score: 18). One hundred and fifty-six patients underwent 296 unique pouch evaluations. Fifty-two percent of patients were male, the median age at the time of evaluation was 43 years (IQR 35–58), and the median pouch age from the closure of the ileostomy was 10 years (IQR 2.5–15). The median [IQR] FC values were significantly lower in patients without pouchitis than in patients with pouchitis (208 [96–478] vs. 550 [250–1051] ug/g, p<0.0001). Mean FC values were lower in patients with lower endoscopic and histologic scores when compared to higher scores, with a significant linear trend for higher FC levels with increasing endoscopic and histologic disease activity. FC performed better than CRP as a predictor of pouchitis. A FC of over 400 ug/g had over 80% specificity for predicting significant endoscopic disease. FC levels increase among patients with pouchitis and increase with increasing endoscopic and histologic inflammation. A FC of over 400 ug/g had good discriminative ability as a predictor of significant endoscopic disease. We suggest that in patients with symptoms of pouchitis and an FC level above 400 ug/g, antibiotic treatment can be initiated without awaiting pouchoscopy. Further research is needed to define FC concentrations more precisely among various outcome measures of interest in these patients.