Serial fecal calprotectin changes in children with Crohn's disease on treatment with exclusive enteral nutrition: Associations with disease activity, treatment response, and prediction of a clinical relapse

Background: Exclusive enteral nutrition (EEN) induces clinical remission in pediatric Crohn's disease (CD). GOALS: This study explored changes in fecal calprotectin concentration during treatment with EEN. STUDY: Fecal calprotectin was measured in 4 serial stool samples from CD children during EEN. The Pediatric Crohn's Disease Activity Index (PCDAI) and systemic markers of disease activity were measured at the beginning and end of treatment. Results: Fifteen CD children (7 girls; 11.6±2.3 y) participated. PCDAI decreased in 14 children and 7 children achieved clinical remission (PCDAI =10). Fecal calprotectin concentration decreased (30 d, P=0.014; 60 d, P<0.0001) only in those children who entered clinical remission (PCDAI =10). In the whole group mean calprotectin concentration at baseline (2158±642 mg/kg) was reduced by 975 mg/kg (95% confidence interval -1783; -167) after 30 days and 1700 mg/kg (95% confidence interval -2508; -892) on EEN completion. Only one child reached normal levels by the end of EEN. Decrease of pretreatment calprotectin levels by more than 18% after 30 days on EEN predicted clinical response at the end of EEN. Calprotectin levels at the end of EEN treatment did not predict the length of time lapsed to a future relapse. Conclusions: In this pilot study calprotectin decreased in patients who achieved clinical remission and may be useful to predict response to treatment. Copyright © 2011 by Lippincott Williams & Wilkins