Evaluation of bowel wall flow by color Doppler ultrasound in the assessment of inflammatory bowel disease activity in pediatric patients / Avaliação do fluxo parietal pela ultrassonografia com Doppler em cores no diagnóstico de atividade na doença inflamatória intestinal em pacientes pediátricos

Abstract Objective: To assess inflammatory bowel disease (IBD) activity with Doppler ultrasound in pediatric patients, comparing the accuracy of the ultrasound findings with that of the concentrations of fecal calprotectin (FC). Materials and Methods: In a consecutive series, we evaluated 53 examinations of 44 pediatric patients seen between 2014 and 2020: 28 with Crohn's disease, 15 with ulcerative colitis, and one with IBD unclassified. The diagnosis of IBD was made in accordance with the Porto criteria. The alteration studied in the greatest detail was bowel wall flow, which was classified by the lead investigator and two pediatric radiologists, all of whom were blinded to the FC concentrations and the other ultrasound findings. Bowel wall flow was categorized as low if there were up to 2 Doppler ultrasound signals/cm2, moderate if there were 3-5 signals/cm2, and high if there were more than 5 signals/cm2. Results: The agreement among the radiologists was substantial (kappa = 0.73). In cases in which ultrasound showed low bowel wall flow, the median FC concentration was 92 µg/g (interquartile range, 33-661 µg/g), whereas it was 2,286 µg/g (interquartile range, 1,728-5,612 µg/g) in those in which ultrasound showed high bowel wall flow. In the sample as a whole, the sensitivity and specificity of ultrasound was 89.7% and 92.0%, respectively, for the detection of inflammatory activity; 95.5% and 90.9%, respectively, for the detection of Crohn's disease; and 81.3% and 100.0%, respectively, for the detection of ulcerative colitis. Conclusion: Ultrasound of the bowel wall showed a strong correlation with FC concentrations in the assessment of inflammatory activity in pediatric patients with IBD.

Resumo Objetivo: Avaliar a atividade da doença inflamatória intestinal (DII) por ultrassonografia (US) com Doppler em cores, comparada à concentração de calprotectina fecal (CF) em pacientes pediátricos. Materiais e Métodos: Em uma série consecutiva, no período entre 2014 e 2020, foram avaliados 53 exames de 44 pacientes pediátricos: 28 casos de doença de Crohn, 15 de colite ulcerativa e um de colite indeterminada. O diagnóstico da DII foi feito pelos critérios de Porto. O fluxo parietal foi a alteração estudada mais detalhadamente e classificada pelo pesquisador principal e por dois radiologistas pediátricos cegados aos valores de CF e de US Doppler. Baixo fluxo parietal foi definido pela captação de até 2 sinais de US Doppler/cm2, fluxo moderado entre 3 e 5 sinais/cm2 e alto fluxo mais de 5 sinais/cm2. Resultados: Houve concordância substancial entre os radiologistas (kappa = 0,73). Nos exames com baixo fluxo parietal a CF média foi 92 μg/g (intervalo interquartil: 33-661 μg/g) e nos exames com alto fluxo a CF média foi 2.286 μg/g (intervalo interquartil: 1.728-5.612 μg/g). Na amostra total, a US demonstrou sensibilidade de 89,7% e especificidade de 92,0% para detecção da atividade inflamatória, 95,5% e 90,9% na doença de Crohn e 81,3% e 100,0% na colite ulcerativa, respectivamente. Conclusão: Houve forte correlação entre a US da parede intestinal e os valores da concentração de CF na avaliação da atividade inflamatória na DII de pacientes pediátricos.

Diagnosis of periprosthetic joint infection based on semi-quantitative detection of synovial fluid calprotectin by MALDI-TOF MS / 中华检验医学杂志

Objective:To explore the clinical value of synovial fluid calprotectin for the diagnosis of periprosthetic joint infection (PJI).Methods:Based on prospective cohort study design, a total of 82 patients suspected of PJI after hip and knee arthroplasty in the First Medical Center of the PLA General Hospital from July 2021 to June 2022 were selected. Patients were divided into infection group (PJI, n=39) and non-infection group (non-PJI, n=43) according to the diagnostic criteria proposed by the Second International Consensus Conference in 2018. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for double-blind detection of calprotectin and internal reference standard (IRS) in synovial fluid of patients. The peaks of target protein and IRS were recorded for further analysis. Mann-Whitney U test was used to compare the concentrations of S100A8 and S100A9 between the two groups, and receiver operating characteristic curve (ROC) was used to analyze the diagnostic efficacy of S100A8 and S100A9 for PJI. Results:Calprotectin was detected as monomers S100A8 and S100A9. Synovial fluid S100A8 was significantly higher in the PJI group than that in the non-PJI group [1.57 (0.48, 4.17) vs 0.00 (0.00, 0.05), Z=?7.221, P<0.05]. Synovial fluid S100A9 was also significantly higher in the PJI group than that in the non-PJI group [0.74 (0.29, 1.70) vs 0.06 (0.00, 0.10), Z=?6.255, P<0.05]. When using S100A8 and S100A9 to diagnose PJI, the sensitivity were 97.4% and 87.2%, the specificity were 86.0% and 88.4%, and the area under the ROC were 0.964 (95% CI 0.929-0.998) and 0.902 (95% CI 0.924-0.996), respectively. Conclusion:The detection of synovial fluid S100A8 and S100A9 by MALDI-TOF MS can make a satisfactory diagnosis for PJI.

Fecal calprotectin levels used as a noninvasive method for screening for chronic gastritis in pediatric patients. A descriptive study

ABSTRACT BACKGROUND: Gastritis consists of inflammation of the gastric mucosa and is one of the main causes of dyspeptic symptoms in children. OBJECTIVE: To investigate the presence of inflammation by evaluating fecal calprotectin (FC) in children diagnosed with chronic gastritis. DESIGN AND SETTING: Descriptive study in Pediatric Gastroenterology Department of Ondokuz Mayis University Hospital in Turkey. METHODS: Between January 2016 and July 2018, FC levels were compared retrospectively in children with chronic gastritis (histopathology-based diagnosis), patients with inflammatory bowel disease (IBD) and healthy children. RESULTS: A total of 67 chronic gastritis patients (61.2% girls) with a mean age of 13.09 ± 3.5 years were evaluated. The mean FC levels were 153.4 μg/g in the chronic gastritis group, 589.7 μg/g in the IBD group and 43.8 μg/g in the healthy group. These levels were higher in chronic gastritis patients than in healthy individuals (P = 0.001) and higher in IBD patients than in the other two groups (P < 0.001). The FC level in the patients with chronic active gastritis (156.3 μg/g) was higher than in those with chronic inactive gastritis (150.95 μg/g) (P = 0.011). Among the patients with chronic active gastritis, the FC level was significantly higher in Helicobacter pylori-positive individuals than in negative individuals (P = 0.031). CONCLUSION: We confirmed the association between increased FC and chronic gastritis. Elevated FC levels may be seen in patients with chronic active gastritis. In order to be able to use FC as a screening tool for chronic gastritis, further studies in a larger study group are needed.

Nivel de calprotectina fecal en niños sanos menores de 4 años

Introducción: la calprotectina es una proteína del citoplasma de neutrófilos, con propiedades bacteriostáticas. Aumenta en materia fecal en procesos inflamatorios de la mucosa intestinal, siendo un marcador de inflamación. Su cuantificación es un método no invasivo y estable en su procesamiento. Presenta una alta sensibilidad para diferenciar entre enfermedad orgánica y funcional y tiene alto valor predictivo positivo para hallazgo de lesiones a nivel endoscópico. Presenta baja especificidad para diferenciar la etiología de la inflamación. El nivel de calprotectina fecal (CF) es variable de acuerdo a la edad. En niños menores de 4 años se han encontrado concentraciones mayores que en otras edades. Esto se puede explicar por factores como: mayor migración de neutrófilos en la mucosa durante el desarrollo de tolerancia oral, regulación de la microbiota intestinal, inmadurez de la barrera epitelial y el ambiente que rodea al niño con permanente estímulo para su sistema inmunológico. Por lo que no se ha podido establecer el cut off en esta franja etaria. Objetivo: conocer los valores de la CF en niños sanos menores de 4 años para determinar valor normal o cut off. Determinarlo según grupos etarios y por sexo. Método: estudio descriptivo con componente analítico. Se obtiene la muestra de los niños que realizan el coproparasitario para el ingreso escolar. Catalogados como sanos: sin antecedentes personales de enfermedad crónica, sin síntomas por lo menos cuatro semanas anteriores a la toma de la muestra. Buen crecimiento según las curvas OMS. Distribuidos en diferentes regiones geográficas de la zona metropolitana de Montevideo. Se utilizó el kit RIDASCREEN®. Resultados: fueron analizadas 155 muestras; 73 de sexo femenino y 82 sexo masculino. Se distribuyeron en grupos etarios: menor de 1 año (n=11); 1 a 2 años (n=36); 2 a 3 años (n=45); 3 a 4 años (n=63). La mediana fue de 152,2 mg/kg (percentil 50). Rango de 4,1 a 1944 mg/kg. Nuestro cut off fue de 954 mg/kg (percentil 95). Se aplica Wilcoxon test p=0,68 y test Kruskal Wallis p=0,06, sin diferencias significativas entre sexo y grupos etarios respectivamente. Conclusiones: es el primer estudio de CF en una población de niños sanos menores de 4 años en Latinoamérica. La mediana encontrada es mayor que la habitual en niños mayores de 4 años y adultos. Obtuvimos un límite normal de 954 mg/kg. No se encontró diferencia en la concentración según sexo o rango etario. Limitaciones de nuestro estudio: el tamaño y la obtención de la muestra corresponde solamente al departamento de Montevideo.

Summary: Introduction: calprotectin is a protein with bacteriostatic properties, found in cytoplasmic neutrophils. Concentration in fecal matter increases in inflammatory processes of the intestinal mucous membrane, being it an inflammation marker. Quantification involves a non-invasive method, stable during processing. Fecal calprotectin concentration is highly sensitive to differentiate between organic and functional disease and has a high positive predictive value for the finding of endoscopic lesions. It evidences low specificity to distinguish the inflammation's etiology. Fecal calprotectin concentration (FCC) varies according to age. Higher concentrations have been found in children younger than 4 years old, what may be explained by the following factors: greater migration of neutrophils in the mucous during the development of oral tolerance, regulation of gut microbiota, non-mature epithelial tissue and the context the child grows in as a permanent stimulation for his immune system. Thus, cut off has not been established yet for this age group. Objective: to learn about FCC in healthy children younger than 4 years old to determine normal values or cut off. To determine values according to age and sex. Method: descriptive study with an analytic component. A sample of the children who undergo a coproparsitary test upon entering school is taken. A healthy child is regarded to: have no personal history of chronic disease, no symptoms at least in the 4 weeks prior to the sample being taken. Good growth is defined as per the WHO curves. Samples included came from different regions in the Montevideo metropolitan area. The RIDASCREEN® kit was used. Results: 155 samples were analysed, 73 of them corresponding to boys and 82 to girls. As to age: younger than 1 year old (n= 11), from 1 to 2 years old (n= 36), from 2 to 3 years old (n= 45), from 3 to 4 years old (n= 63). Median concentration was 152.2 mg/kg (Percentile 50). Range 4.1 to 1944 mg/kg. Our cut off was 954 mg/kg (percentile 95). Wolcoxon test was applied (p= 0.68) and Kruskal Wallis test (p=0.06), no significant differences were found between sex and age groups respectively. We obtained a normal limit of 954 mg/Kg. No difference was found in the concentration for different sex or age. Limitations of our study result from the size of the sample and the fact that all samples correspond to Montevideo.

Introdução: a calprotectina é uma proteína neutrofílica citoplasmática com propriedades bacteriostáticas. Ela aumenta na matéria fecal durante os processos inflamatórios da mucosa intestinal, e é um marcador de inflamação. Pode ser quantificada utilizando um método não invasivo, estável em seu processamento. Apresenta alta sensibilidade para diferenciar entre doença orgânica e funcional e tem alto valor preditivo positivo para encontrar lesões no nível endoscópico. Apresenta baixa especificidade para diferenciar a etiologia da inflamação. O nível de calprotectina fecal (CF) varia de acordo com a idade, e para o caso de crianças com menos de 4 anos ela teve concentrações mais elevadas, o que pode ser explicado por fatores tais como o aumento da migração de neutrófilos na mucosa durante o desenvolvimento de tolerância oral, regulação da microbiota intestinal, imaturidade da barreira epitelial e ambiente que envolve a criança como estímulo permanente do sistema imunológico. Portanto, não foi possível estabelecer o corte nesta faixa etária. Objetivo: conhecer os valores da FC em crianças saudáveis menores de 4 anos para determinar o valor normal ou o de corte de acordo com as faixas etárias e sexo. Método: estudo descritivo com componente analítico. A amostra foi obtida das crianças que realizaram o estudo coproparasitológico para a admissão escolar. Crianças catalogadas como saudáveis: sem histórico de doença crônica, sem sintomas durante pelo menos 4 semanas antes de experimentar a amostra. Bom crescimento: de acordo com as curvas da OMS. Distribuído em diferentes regiões geográficas da área metropolitana de Montevidéu. Se utilizou o kit RIDASCREEN®. Resultados: foram analisadas 155 amostras: 73 de mulheres e 82 de homens distribuídos em grupos etários: com menos de 1 ano (n = 11), 1 a 2 anos (n = 36), 2 a 3 anos (n = 45), 3 a 4 anos (n = 63). A mediana foi de 152,2 mg / kg (percentil 50). Faixa de 4,1 a 1944 mg / kg. Nosso corte foi 954mg / Kg (percentil 95). Aplicou-se o teste de Wilcoxon p = 0,68 e o teste de Kruskal Wallis p = 0,06, e não observamos diferenças significativas entre os grupos por sexo ou faixa etária, respectivamente. Conclusões: este foi o primeiro estudo de FC numa população de crianças saudáveis com menos de 4 anos de idade na América Latina. A mediana encontrada é maior que a usual em crianças com mais de 4 anos e em adultos. Obtivemos um limite normal de 954mg / Kg. Nenhuma diferença foi encontrada na concentração dependendo do sexo ou faixa etária. As limitações do nosso estudo são o tamanho da amostra e o fato de que a amostra foi obtida apenas de Montevidéu.

Semiquantitative fecal calprotectin test in postinfectious and non-postinfectious irritable bowel syndrome: cross-sectional study / Teste calprotectina fecal semiquantitativa na síndrome do intestino irritável pós-infecciosa e não pós-infecciosa: estudo transversal

CONTEXT AND OBJECTIVE:The presence of a certain degree of inflammation in the gut wall is now accepted in irritable bowel syndrome (IBS). Fecal calprotectin is considered to be a reliable test for detecting intestinal inflammation. Our aim was to assess the presence of inflammation in postinfectious IBS (PI-IBS), compared with non-postinfectious IBS (NPI-IBS). A secondary objective was to determine the usefulness of a rapid fecal calprotectin test in inflammatory bowel diseases (IBD).DESIGN AND SETTING:This was a cross-sectional study. Patients with IBS and IBD at a single tertiary gastroenterology center were prospectively included in this study.METHODS:116 patients with Rome III IBS score (76 females; 48 ± 12 years) were investigated; 24 patients (15 females) had PI-IBS. Intestinal inflammation was assessed using the semiquantitative fecal calprotectin test. The results were expressed as T1, T2 or T3 according to the severity of inflammation (< 15 μg/g; 15-60 μg/g; > 60 μg/g). Using the same test, we evaluated 20 patients with IBD (12 males; 47 ± 13 years).RESULTS:None of the patients with IBS had a T2 or T3 positive test. Among PI-IBS patients, 33% had a T1 positive test. Among NPI-IBS patients, 9.8% had a T1 positive test, which was significantly different to PI-IBS. The calprotectin test was positive in all IBD patients: 80% with T3, 10% with T2 and 10% with T1.CONCLUSIONS:Using a semiquantitative test for fecal calprotectin, positive tests were more frequent in PI-IBS patients than in NPI-IBS patients.

CONTEXTO E OBJETIVO:A presença de certo grau de inflamação na parede do intestino é agora aceita na síndrome do intestino irritável (SII). A calprotectina fecal é considerada teste confiável para detectar inflamação intestinal. Nosso objetivo foi avaliar a presença de inflamação na SII pós-infecciosa (SII-PI), em comparação com a SII não pós-infecciosa (SII-NPI). Um objetivo secundário foi determinar a utilidade de um teste rápido fecal da calprotectina em doenças inflamatórias intestinais (DII).TIPO DE ESTUDO E LOCAL:Este foi um estudo transversal. Pacientes com SII e DII em um único centro terciário de gastroenterologia foram prospectivamente incluídos neste estudo.MÉTODOS:116 pacientes com escore Roma III de SII (76 mulheres, 48 ± 12 anos) foram investigados; 24 pacientes (15 mulheres) tinham SII-PI. Inflamação intestinal foi avaliada pelo teste semi-quantitativo de calprotectina fecal. Os resultados foram expressos como T1, T2 ou T3 de acordo com a gravidade da inflamação (< 15 μg/g; 15-60 mg/g; > 60 mg/g). Usando o mesmo teste, foram avaliados 20 pacientes com DII (12 homens, 47 ± 13 anos).RESULTADOS:Nenhum dos pacientes com SII teve um teste positivo T2 ou T3. Na PI-IBS, 33% tiveram um teste positivo T1. Entre os pacientes SII-NPI, teste T1 positivo estava presente em 9,8%, taxa significativamente diferente quando comparada com SII-PI. O teste de calprotectina foi positivo em todos os pacientes com DII: 80% com T3, 10% com T2 e 10% com T1.CONCLUSÕES:Usando teste semi-quantitativo para calprotectina fecal, relatamos positividade em pacientes SII-PI com mais frequência que em pacientes SII-NPI.

Application of Fecal calprotectin in the clinical diagnosis of inflammatory bowel disease / 中国医师杂志

Objective To investigate the clinical application of fecal calprotectin in inflammatory bowel disease (IBD).Methods Colonoscopy took 79 patients with IBD that were diagnosed with pathology,including 47 cases of ulcerative colitis (UC) patients,32 cases of Crohn's disease (CD).Moreover,42 cases of IBD patients without abdominal pain,diarrhea and other intestinal inflammation were used as disease control group,and 34 cases of healthy people were used as healthy control group.The level of fecal calprotectin in each group was detected by enzyme-linked immunosorbent assay (ELISA).Results The positive rate of fecal Calprotectin in IBD group,disease control group and the healthy control group was 57.0％,19.0％,and 0,respectively; each positive rate in IBD group was significantly higher than the other two groups (P ＜ 0.05).The serum concentration of fecal calprotectin in IBD group [(493.86 ±204.18) μg/g] was significantly higher than the disease control group [(71.46 ± 60.51) μg/g] and the healthy control group [(36.19 ± 13.46) μg/g] (P ＜ 0.05) ; IBD active calprotection [(1015.23 ± 324.96) μg/g] was significantly higher than resting [(52.69 ±34.71) μg/g] (P ＜0.01).Conclusions Fecal calprotectin test benefits early diagnosis of IBD,and may be taken as the diagnostic index of IBD activity.It has extensively clinical value.