Fecal Calprotectin Monitoring in Ulcerative Colitis Follow-Up

Role of Fecal Calprotectin in UC Monitoring

Fecal calprotectin is a sensitive marker of intestinal inflammation that correlates well with endoscopic indices and helps in the assessment of disease severity and response to treatment 2
The American Gastroenterological Association (AGA) suggests a monitoring strategy that combines biomarkers and symptoms rather than symptoms alone for patients with UC in symptomatic remission (conditional recommendation, moderate certainty of evidence) 1
Interval biomarker monitoring may be performed every 6–12 months, with fecal calprotectin being the optimal choice for monitoring 1

Patients with elevated fecal calprotectin (>150 μg/g) are 4.4 times more likely to experience disease relapse compared to those with normal levels 3
With an observed median annual risk of relapse of 15% in patients with normal fecal calprotectin, the estimated annual risk of relapse in patients with elevated levels rises to 64% 3

For patients in symptomatic remission, interval monitoring with fecal calprotectin every 6-12 months is recommended 1
For patients who have had recent treatment adjustments, more frequent monitoring (every 3-6 months) may be appropriate to assess response 4
After initiating or adjusting therapy, repeat fecal calprotectin measurement is recommended in 2-4 months to monitor response, according to the American Gastroenterological Association 4

Fecal calprotectin <150 μg/g in patients with UC in symptomatic remission reliably rules out active inflammation, avoiding the need for endoscopic assessment 6
Fecal calprotectin >150 μg/g indicates active intestinal inflammation that may require treatment adjustment or further evaluation 4
Fecal lactoferrin is another stool biomarker that can be used, with a sensitivity of 83% and specificity of 75% for detecting endoscopic inflammation 6