Faecal calprotectin or lactoferrin can identify postoperative recurrence in Crohn's disease

Background: Identifying Crohn's disease recurrence in symptomatic patients after ileocaecal resection is difficult. The aim of this study was to evaluate faecal concentrations of granulocyte degradation products in this setting. Methods: A postoperative cohort of 13 patients was followed prospectively for 1 year with regular faecal calprotectin (FC) and lactoferrin (FL) measurements. A second postoperative cohort (median 24 months after resection) of 104 patients provided a single stool sample. Faecal measurements were compared with symptom diaries, the Harvey Bradshaw Index, endoscopic examination, C-reactive protein and platelet measurement. Results: In the uncomplicated course, both markers normalized within 2 months. Both FC and FL correlated significantly with Harvey Bradshaw Index (P < 0.001). Twenty-eight patients with severely clinically active disease had high mean(s.e.) levels of FC (661.1(119.1) mu g/g) and FL (116.6(32.2) mu g/g); and 43 with clinically inactive disease had low levels of FC (70.2(27.1) mu g/g) and FL (5.9(2.4) mu g/g). In patients with mild to moderately clinically active disease, FC and FL identified individuals with and without recurrent inflammatory disease. Faecal markers were more accurate at predicting clinical disease activity, than C-reactive protein, platelet count or endoscopic appearance. Conclusion: FC and FL are non-invasive tests that can help to identify disease recurrence in symptomatic postoperative patients.