Focus of the Report: This report focuses on fecal calprotectin (FC) testing to monitor disease activity and guide therapy choices in patients who have ulcerative colitis (UC).

Technology Description: Calprotectin is a calcium-binding protein that is abundant in neutrophils. During active intestinal inflammation, neutrophils are recruited to the inflamed intestinal mucosa and these cells release calprotectin into the stool. Levels of FC correlate with the number of neutrophils present in the gut mucosa, making it a specific marker for intestinal inflammation. Testing is conducted on outpatients and the results interpreted by a gastroenterologist. Test results are used in conjunction with clinical evaluation and other diagnostic tests.

Controversy: Although FC testing enables noninvasive monitoring of UC disease activity, it is not as accurate as colonoscopy. Furthermore, FC levels can be elevated by gastrointestinal infections, colorectal cancer, and use of nonsteroidal anti-inflammatory drugs, potentially leading to false-positive FC results.

Key Questions:

  • What is the clinical validity of FC relative to colonoscopy to monitor disease activity in UC?

  • What is the clinical utility of FC to monitor disease activity in UC?

  • How does FC compare with other interventions for monitoring of disease activity in UC?

  • Are any safety issues associated with the FC test?

  • Have definitive patient selection criteria been established for use of the FC test to monitor UC?

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