Inflammatory bowel diseases · 2026
Fecal calprotectin is an accurate noninvasive screening tool for pouchitis.
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Bronze Sérgio, Ibing Susanne, Jimenez Darwin, Mercedes Pamela Reyes, Kayal Maia
Аннотация
BACKGROUND: Pouchitis is the most common complication after ileal pouch anal anastomosis (IPAA), yet symptoms are non-specific, and diagnosis typically requires pouchoscopy. Fecal calprotectin (FC) is an established inflammatory bowel disease biomarker, but optimal thresholds and diagnostic performance across distinct pouch phenotypes remain unclear.
METHODS: We performed an analysis of a prospectively maintained IPAA registry (2022-2025) at Mount Sinai Hospital. Adults with ulcerative colitis who had underwent total proctocolectomy with IPAA and had FC testing within ±90 days of pouchoscopy were included. Phenotypes were categorized as normal pouch (NP), acute pouchitis (AP), chronic pouchitis (CP), or Crohn's disease-like pouch inflammation (CDLPI). FC was compared across phenotypes and tested for associations with endoscopic Pouchitis Disease Activity Index (PDAI) sub-score, histologic activity, and symptoms using non-parametric tests, Spearman correlation, log-linear regression, and receiver operating characteristic analysis.
RESULTS: Among 163 patients, FC differed significantly across pouch phenotypes (P <.01) with a median value of 50.5 µg/g in NP, 244 µg/g in AP, 370.5 µg/g in CP, and 231.5 µg/g in CDLPI. FC distinguished between inflammatory and normal pouches with an area under the curve (AUC) of 0.82, with an optimal threshold of ∼167 µg/g (specificity, 94%). FC correlated significantly with endoscopic PDAI sub-scores (Spearman ρ = 0.45, P <.001), and predicted severe endoscopic activity with an AUC of 0.82 and an optimal cutoff of 280 µg/g.
CONCLUSION: FC is accurate for detecting and grading pouch inflammation. Thresholds near 167 and 280 µg/g reliably discriminate normal from inflamed pouches and mild from severe endoscopic disease, respectively.
METHODS: We performed an analysis of a prospectively maintained IPAA registry (2022-2025) at Mount Sinai Hospital. Adults with ulcerative colitis who had underwent total proctocolectomy with IPAA and had FC testing within ±90 days of pouchoscopy were included. Phenotypes were categorized as normal pouch (NP), acute pouchitis (AP), chronic pouchitis (CP), or Crohn's disease-like pouch inflammation (CDLPI). FC was compared across phenotypes and tested for associations with endoscopic Pouchitis Disease Activity Index (PDAI) sub-score, histologic activity, and symptoms using non-parametric tests, Spearman correlation, log-linear regression, and receiver operating characteristic analysis.
RESULTS: Among 163 patients, FC differed significantly across pouch phenotypes (P <.01) with a median value of 50.5 µg/g in NP, 244 µg/g in AP, 370.5 µg/g in CP, and 231.5 µg/g in CDLPI. FC distinguished between inflammatory and normal pouches with an area under the curve (AUC) of 0.82, with an optimal threshold of ∼167 µg/g (specificity, 94%). FC correlated significantly with endoscopic PDAI sub-scores (Spearman ρ = 0.45, P <.001), and predicted severe endoscopic activity with an AUC of 0.82 and an optimal cutoff of 280 µg/g.
CONCLUSION: FC is accurate for detecting and grading pouch inflammation. Thresholds near 167 and 280 µg/g reliably discriminate normal from inflamed pouches and mild from severe endoscopic disease, respectively.