Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

BackgroundFecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children.MethodsAltogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age ≤ 18 years were included.ResultsIleocecal resection (n = 15), small bowel resection (n = 6), or left hemicolectomy (n = 1) was performed at median age of 15.1 (interquartile range 14.4–17.6) years. Following surgery, FC decreased significantly (659 vs. 103 μg/g, p = 0.001). During median follow-up of 5.7 (4.2–7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC > 139 μg/g at time of endoscopy or FC increase of 79 μg/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC > 101 μg/g or increase of 21 μg/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58–0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67–0.95) for histological recurrence.ConclusionFC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients.