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Yun Qiu, Reply to Can Fecal Calprotection Identify Postoperative Recurrence of Crohn's Disease?, Inflammatory Bowel Diseases, Volume 21, Issue 5, 1 May 2015, Page E7, https://doi.org/10.1097/MIB.0000000000000416
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Reply:
We wish to thank Dr. Cong Dai et al for their letter concerning our study on the use of fecal calprotectin (FC) for evaluating recurrence of postoperative patients with Crohn's disease (CD). They raised some concerns on both the sensitivity and specificity (e.g., intraindividual variability) of FC during the investigation of suspected endoscopic recurrence and the possibility of FC to replace endoscopy.
Previous work has already shown that FC outperforms commonly used C-reactive protein, Crohn's Disease Activity Index, and other fecal markers, including fecal lactoferrin and fecal S100A12, in identifying the recurrence of postoperative CD.1,2 The recent Postoperative Crohn's Endoscopic Recurrence multicenter randomized study also proved FC correlated with endoscopic recurrence and Rutgeert's score (P < 0.001), whereas C-reactive protein and Crohn's Disease Activity Index did not. FC > 100 μg/g indicated endoscopic recurrence with a sensitivity of 89% and NPV of 91%, potentially allowing avoidance of colonoscopy in 41% of patients.3 Regarding intraindividual variability, Naismith et al4 demonstrated good correlation across 3 samples, thus using a set of 2 to 3 instead of single samples may be an option to correct for this variability.
