Purpose of Technology: Mucosal healing is emerging as a primary therapeutic target for Crohn disease (CD), as a growing body of evidence suggests that it is associated with better patient outcomes. The definitive standard for assessing intestinal inflammation is ileocolonoscopy; however, this technique is invasive, time-consuming, expensive, and carries a risk of complications. Calprotectin is a specific, neutrophil-derived, calcium-binding protein that can be measured in small stool samples and used as a marker of intestinal inflammation.

Rationale: Fecal calprotectin (FC) testing may provide a noninvasive, cost-effective alternative to ileocolonoscopy to predict and monitor disease activity in patients with CD.

Controversy: While FC testing presents a noninvasive approach for monitoring disease activity, it has several potential disadvantages, including: diminished value in patients with CD restricted to the small bowel; imperfect correlation with transmural inflammation; and elevation of levels due to infectious enterocolitis, colorectal cancer, or use of nonsteroidal anti-inflammatory drugs, potentially leading to false-positive FC results. Moreover, optimal FC cutoff values to distinguish endoscopically active disease, endoscopic remission, or clinical relapse have yet to be established.

Relevant Questions:

  • What is the clinical validity of the FC assay to predict and monitor disease activity in CD?
  • What is the clinical utility of the FC assay to predict and monitor disease activity in CD?
  • Is FC testing safe for use in patients with CD?
  • Have definitive patient selection criteria been established for use of FC to predict and monitor CD?

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