J Crohns Colitis. 2021 Oct 11:jjab182. doi: 10.1093/ecco-jcc/jjab182. Online ahead of print.
BACKGROUND: Severe Crohn's disease (CD) can result in extensive bowel resections and need for creation of an ileostomy. Fecal calprotectin (FC) is well studied in CD management though its role in patients who have an ileostomy is unclear. Our aim is to understand if FC is a useful adjunct to radiographic or endoscopic studies in identifying recurrent CD after surgery in patients with an ileostomy.
METHODS: Between 1/1/2017 and 09/30/2020, we searched the Mayo Clinic electronic medical record retrospectively for adult patients with ICD-10 code for CD, and a surgical history of an ileostomy. Patients were included in the analysis if they had at least one FC measured and a concomitant radiographic imaging and/or endoscopic procedure. An abnormal FC was defined as greater than 60 mcg/g.
RESULTS: Fifty-one patients met our inclusion criteria, 17 had a FC level >60 mcg/g. Of these 17 patients, 14 had imaging and/or an ileoscopy confirming the presence of small bowel inflammation with a sensitivity of 87.5%. Of the remaining 34 patients with a FC level ≤60 mcg/g, 32 patients had imaging and/or ileoscopy demonstrating no small bowel inflammation with a specificity of 91.4%. FC from an ileostomy effluent had a positive predictive value of 82.3%, a negative predictive value of 94.1% and test diagnostic accuracy of 90.1%.
CONCLUSION: FC from an ileostomy effluent is a highly sensitive and specific test for the assessment and monitoring of small bowel inflammation and disease recurrence in patients with CD.
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