Intest Res.  2016 Jan;14(1):5-14. 10.5217/ir.2016.14.1.5.

Fecal immunochemical test as a biomarker for inflammatory bowel diseases: can it rival fecal calprotectin?

• Kato J
• Hiraoka S
• Nakarai A
• Takashima
• Inokuchi T
• Ichinose M

• KMID: 2174504
• DOI: http://doi.org/10.5217/ir.2016.14.1.5

Abstract

Accurate evaluation of disease activity is essential for choosing an appropriate treatment and follow-up plan for patients with inflammatory bowel disease (IBD). Endoscopy is required for accurately evaluating disease activity, but the procedures are sometimes invasive and burdensome to patients. Therefore, alternative non-invasive methods for evaluating or predicting disease activity including mucosal status are desirable. Fecal calprotectin (Fcal) is the most widely used fecal marker for IBD, and many articles have described the performance of the marker in predicting disease activity, mucosal healing (MH), treatment efficacy, and risk of relapse. Fecal immunochemical test (FIT) can quantify the concentration of hemoglobin in stool and was originally used for the screening of colorectal cancer. We recently reported that FIT is also a useful biomarker for IBD. A direct comparison between the use of Fcal and FIT showed that both methods predicted MH in ulcerative colitis equally well. However, in the case of Crohn's disease, FIT was less sensitive to lesions in the small intestine, compared to Fcal. FIT holds several advantages over Fcal in regards to user-friendliness, including a lower cost, easy and clean handling, and the ability to make rapid measurements by using an automated measurement system. However, there is insufficient data to support the application of FIT in IBD. Further studies into the use of FIT for evaluating the inflammatory status of IBD are warranted.

Keyword

Ulcerative colitis; Crohn disease; Endoscopy; Fecal immunochemical test; Fecal calprotectin

MeSH Terms

Colitis, Ulcerative
Colorectal Neoplasms
Crohn Disease
Endoscopy
Follow-Up Studies
Humans
Inflammatory Bowel Diseases*
Intestine, Small
Leukocyte L1 Antigen Complex*
Mass Screening
Recurrence
Treatment Outcome
Leukocyte L1 Antigen Complex

Figure

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  Fig. 1 A complete picture of the OC-sensor DIANA. The equipment can measure up to 150 samples in a single session.

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  Fig. 2 Fecal sampling for OC-sensor. (A) OC-hemodia sampling probe and the container. (B) For the collection of stools, patients insert the sampling probe into several different areas of the stool sample.

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  Fig. 3 Correlation between fecal immunochemical test (FIT) values and colonoscopic findings. The FIT value was positively correlated with endoscopic activity (Spearman rank correlation coefficient, 0.54; P<0.0001). The figure was reproduced from Nakarai et al. (2013).19 Hb, hemoglobin. *Cochran-Armitagetrend test.

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  Fig. 4 The direct comparison of FIT and Fcal. (A) Correlation between fecal immunochemical test (FIT) or Fcal values and colonoscopy findings. (a) FIT results significantly correlated with the Mayo endoscopic subscore (MES) in the portion of the colorectum with maximum activity (Spearman rank correlation coefficient [r]=0.61; P<0.0001). (b) Fcal levels significantly correlated with the maximum MES (r=0.58; P<0.0001). (B) Correlation between FIT values and Fcal levels. In each patient, FIT values significantly correlated with Fcal values (r=0.64; P<0.0001). The figure was reproduced from Takashima et al. (2015).29

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  Fig. 5 Change in endoscopic activity and fecal immunochemical test (FIT) value of a patient with UC who was treated with tacrolimus. The FIT values reflected the improvement of endoscopic activity induced by tacrolimus treatment. MES, Mayo endoscopic subscore.

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  Fig. 6 Disease course of a patient with UC who relapsed. The fecal immunochemical test (FIT) value became higher approximately 3 weeks before clinical symptoms relapsed.

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