Predicting Outcomes in IBD with Fecal Biomarkers

While fecal biomarkers have been proposed as a treatment target for inflammatory bowel disease (IBD), their suggested use in clinical practice has not been established. To uncover a potential relationship between fecal biomarkers and IBD-related complications, a recent study published in Inflammatory Bowel Diseases assessed whether fecal calprotectin (fCal) and fecal myeloperoxidase (fMPO) could help predict outcomes in patients with IBD.

Evaluating fCal and fMPO as Disease Course Predictors

Based in Christchurch, New Zealand, the study included 171 participants with IBD (99 with Crohn's disease and 72 with ulcerative colitis). Researchers from University of Otago Christchurch monitored these patients for 24 months, assessing them for elements of a complicated IBD course. These key factors included incident corticosteroid use, medication escalation for clinical disease relapse, or IBD-related hospitalizations or surgeries.

The study revealed that baseline fCal and fMPO levels effectively predicted a complicated IBD course:

• A baseline fCal of 250 μg/g (AUROC = 0.77; 95% CI, 0.69-0.84) and fMPO of 12 μg/g (AUROC = 0.77; 95% CI, 0.70-0.84) were predictive of adverse outcomes
• After adjusting for baseline variables, including clinical disease activity, both fCal (adjusted OR = 7.85; 95% CI, 3.38-18.26) and fMPO (adjusted OR = 4.43; 95% CI, 2.03-9.64) remained significantly associated with a complicated IBD course

Additionally, C-reactive protein (CRP) was inferior to fecal biomarkers and clinical symptoms in predicting a complicated IBD course. The greatest precision in identifying a complicated IBD course was achieved by combining baseline CRP, fCal and fMPO, and clinical symptoms.

Implications for IBD Management

These findings suggest that fCal and fMPO can serve as valuable tools for risk stratification, allowing us to identify patients at higher risk of complications. By proactively monitoring these biomarkers, clinicians can tailor treatment strategies to prevent disease progression and improve long-term outcomes.

The study also emphasizes the importance of integrating fecal biomarkers into routine clinical care. While ileocolonoscopy remains the gold standard for objective disease assessment in IBD, it is both invasive and expensive. Fecal biomarkers offer a non-invasive and cost-effective alternative for monitoring intestinal inflammation and predicting disease outcomes.

References:

Swaminathan, A, Borichevsky, GM, Frampton, CM, Day, AS, Hampton, MB, Kettle, AJ, Gearry, RB. Comparison of fecal calprotectin and myeloperoxidase in predicting outcomes in inflammatory bowel disease. Inflammatory Bowel Diseases. 2024,31(1):28-30. https://doi.org/10.1093/ibd/izae032.