G. Laino

From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting

Fecal calprotectin (FC) has emerged as one of the most useful tools for clinical management of inflammatory bowel diseases (IBD). Many different methods of assessment have been developed and different cut-offs have been suggested for different clinical settings. We carried out a comprehensive literature review of the most relevant FC-related topics: the role of FC in discriminating between IBD and irritable bowel syndrome (IBS) and its use in managing IBD patients In patients with intestinal symptoms, due to the high negative predictive value a normal FC level reliably rules out active IBD. In IBD patients a correlation with both mucosal healing and histology was found, and there is increasing evidence that FC assessment can be helpful in monitoring disease activity and response to therapy as well as in predicting relapse, post-operative recurrence or pouchitis. Recently, its use in the context of a treat-to-target approach led to a better outcome than clinically-based therapy adjustment in patients with early Crohn’s disease. In conclusion, FC measurement represents a cheap, safe and reliable test, easy to perform and with a good reproducibility. The main concerns are still related to the choice of the optimal cut-off, both for differentiating IBD from IBS, and for the management of IBD patients.

Mo1120 The First 30-min Basal Impedance Levels Highly Correlate With the 24-Hour Values and Lower Values Are Associated With a Positive 24-h Impedance-pH Monitoring

Objectives: Recent data indicate that low esophageal baseline impedance (BI) measurements may reflect the status of the esophageal mucosa. We aimed to correlate the first 30-min baseline impedance (BI) levels with the 24-h BI values in patients with heartburn and negative endoscopy. Moreover, we correlated those values with the results of 24-h impedancepH.Methods: Sixty patients with heartburn and negative endoscopy underwent 24-h impedance-pH testing off-therapy and were sub-categorized in: a) patients with abnormal acid exposure time (AET) and/or number of refluxes (NERD); b) patients with pathophysiological characteristics related to functional heartburn (FH). Impedance-pH tracks were manually evaluated to assess the mean 24-h BI (15-min time window for each hour, avoiding refluxes and swallowing) and the first 30-min BI after the placement of the probe. Moreover, AET, number of refluxes and symptom/reflux correlation (SAP) were measured. Results: NERD showed a higher mean AET (6.3±1.6% vs 0.6±0.3%, p<0.05) and reflux number (78.1±23 vs 15.4±9.8, p<0.05) compared to FH. FH had a 100% negative SAP. The first 30-min BI was lower in NERD (1126.9±144.5) than in FH (3867.5±486.8) (p<0.001). There were no differences between the 24-h BI and the 30-min BI in both groups (1126.9±144.5 vs 1101±215.4 in NERD and 3867.5±486.8 vs. 3624.4±347.5 in FH; p=n.s.). We found a strong inverse correlation between BI (24-h and 30-min) and AET or total number of reflux events (see Figure 1). Conclusions: The 30-min BI levels directly correlate with 24-h BI and inversely correlate with AET. Moreover, the 30-min BI levels appear much lower in patients with a diagnosis of NERD at impedance-pH testing.