Fecal calprotectin in patients with concomitant primary sclerosing cholangitis and inflammatory bowel disease: a systematic review and meta-analysis.

BACKGROUND

Primary sclerosing cholangitis (PSC) is strongly associated with inflammatory bowel disease (IBD), with up to 70% of PSC patients having concomitant IBD (PSC-IBD). Fecal Calprotectin (FC) is a validated surrogate biomarker of intestinal inflammation in IBD. Emerging evidence suggests that FC may also reflect biliary inflammation in PSC.

AIM: This study aimed to compare FC concentrations in patients with PSC-IBD versus IBD only.

METHODS

A systematic literature search was performed (PROSPERO registration no. CRD42024600985). Studies reporting FC levels in both PSC-IBD and IBD-only patients were included. The outcome of interest was the difference in mean FC concentration between the two groups.

RESULTS

Seven studies met the inclusion criteria. There was no significant difference in the mean FC levels between PSC-IBD and IBD patients (-5.10, 95% confidence interval [CI] -45.40 to -35.2; p= 0.8). The findings remained non-significant when endoscopic remission was considered (12.82, 95% CI -19.33 to 44.97; p= 0.43).

CONCLUSIONS

FC levels did not significantly differ between PSC-IBD and IBD groups. The available evidence is limited and heterogeneous. Larger, well-designed studies are needed to determine whether FC can serve as a surrogate biomarker of PSC progression, particularly in patients with endoscopic remission of colitis or without concomitant IBD.