Ulcerative Colitis Management

Diagnostic Stool Testing

Fecal calprotectin is a primary biomarker for assessing inflammation in ulcerative colitis, with a cutoff of >150 μg/g indicating active inflammation, as recommended by the American Gastroenterological Association 1, 3
Stool testing for Clostridioides difficile and other enteric pathogens is essential to rule out infectious causes, especially in patients with elevated biomarkers and disease-related symptoms, according to the American Gastroenterological Association 1, 4
Fecal lactoferrin serves as another neutrophil-derived marker that correlates well with histological inflammation, as noted by the American Gastroenterological Association 2

Fecal calprotectin <150 μg/g suggests minimal inflammation and can rule out active inflammation in patients in symptomatic remission, as recommended by the American Gastroenterological Association 3, 5
In patients who have recently achieved symptomatic remission after treatment adjustment, a lower cutoff of <50 μg/g may be preferred to detect endoscopic improvement, according to the American Gastroenterological Association 3, 5

For patients with moderate to severe symptoms and elevated biomarkers, treatment adjustment can be made without endoscopic assessment, as recommended by the American Gastroenterological Association 2, 6
For patients with mild symptoms and elevated biomarkers, endoscopic assessment is suggested before treatment adjustment, according to the American Gastroenterological Association 2, 3

Fecal calprotectin should be repeated every 6-12 months in patients in symptomatic remission, as recommended by the American Gastroenterological Association 5
Biomarkers may be less accurate in detecting endoscopic inflammation in patients with ulcerative proctitis or limited segmental disease, as noted by the American Gastroenterological Association 1, 3
Biomarkers have no role in dysplasia detection and surveillance, which requires endoscopic evaluation, according to the American Gastroenterological Association 1, 3