Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy

Inas Elkhedr Mohamed; Fatma Ahmed Ali-Eldin

doi:doi:10.11648/j.ijcems.20170306.14

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Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy

Inas Elkhedr Mohamed, Fatma Ahmed Ali-Eldin

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 3, Issue 6)

Received: 26 February 2017 Accepted: 24 March 2017 Published: 5 December 2017

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Abstract

Fecal calprotectin is considered a valid marker of intestinal inflammation and its high level in patients with HE may be explained by small intestinal bacterial overgrowth. This study aimed to assess the role of fecal calprotectin in diagnosis and follow up of patients with hepatic encephalopathy. Fifteen patients with uncomplicated liver cirrhosis, 30 patients with liver cirrhosis complicated by hepatic encephalopathy (HE) and 15 healthy subjects were enrolled. All participants were subjected to: clinical examination, laboratory investigations (CBC, liver function tests, kidney functions, HBs Ag and HCV Antibody), fecal calprotectin concentration, abdominal ultrasound. Severity of HE was assessed according to West–Haven criteria. Patients with HE was managed using metronidazole and rifaximin and fecal calprotectin concentrations were reassessed. The level of fecal calprotectin is significantly higher in patients with Child-Pugh class B (116±12 mg/kg) versus that in class A (66±15 mg/kg) (p<0.01). FC concentrations showed the lowest value in the cirrhotic group (66+15 mg/kg) followed by low grade HE (195+12mg/kg) and the highest value in the high grade HE group (489+23mg/kg) (p<0.01). A significant decrease in FC concentrations occurred in HE group after receiving treatment, reaching a level of 273+42.68 mg/kg versus 364+83.12 mg/kg before rifaximin. In conclusion: Fecal calprotectin can be used in diagnosis of HE. Significant high levels of fecal calprotectin in high grade HE patients and its reduction following effective treatment could consider fecal calprotectin as a follow up marker in association with clinical signs in patients with HE.

Published in	International Journal of Clinical and Experimental Medical Sciences (Volume 3, Issue 6)
DOI	10.11648/j.ijcems.20170306.14
Page(s)	82-86
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Fecal Calprotectin, Liver Cirrhosis, Hepatic Encephalopathy

References

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[2]	R. D' Inca, E. Dal Pont, V. Di Leo, L. Benazzato, M. Martinato, F. Lambogia, L. Oliva, G. C. Sturniolo, "Can calprotectin predict relapse risk in inflammatory bowel disease?" Am. J. Gastroenterol., vol. 103, pp. 2007-2014, 2012.
[3]	P. Ferenci, A. Lockwood, K. Mullen, R. Tarter, K. Weissenborn, A. T. Blei, "Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congress of Gastroenterology, Vienna, 1998". Hepatology, vol. 35, pp. 716–721, 2012.
[4]	A. Mas, J. Rodes, L. Sunyer, L. Rodrigo, R. Planas, V. Vargas, et al., "Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial." J. Hepatol., vol. 38 (1): pp. 51-8, 2013.
[5]	S. Joshi, S. J. Lewis, S. Creanor, R. M. Ayling, "Age-related fecal calprotectin, lactoferrin and tumour M2-PK concentrations in healthy volunteers". Annals of Clinical Biochemistry, Vol. 47 (3): pp. 259–263, 2009.
[6]	W. J. Cash, P. McConville, E. McDermott, P. A. McCormick, M. E. Callender, N. I. McDougall. "Current concepts in the assessment and treatment of hepatic encephalopathy". Q. J. M., vol. 103 (1), pp. 9–16, 2013.
[7]	A. Gupta, R. K. Dhiman, S. Kumari, S. Rana, R. Agrawal, A. Duseja, Y. Chawla. "Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy". J. Hepatol. Vol. 53, pp. 849–55, 2015.
[8]	F. Gundling, F. Schmidtler, A. Hapfelmeier, B. Schulte, T. Schmidt, C. Pehl, W. Schepp, H. Seidl. "Fecal calprotectin is a useful screening parameter for hepatic encephalopathy and spontaneous bacterial peritonitis in cirrhosis". Liver international, vol. 31 (9), pp. 1406-1415, 2011.
[9]	E. Yagmur, B. Schnyder, D. Scholten, R. Schirin-Sokhan, A. Koch, R. Winograd, A. M. Gressner, C. Trautwein, H. E., Wasmuth "Elevated concentration of fecal calprotectin in patients with liver cirrhosis". Dtsch. Med-Wochenschr., vol. 131 (36), pp. 1930-4, 2015.
[10]	V. A. Gerova, V. N. Nakov, S. G. Stoynov, R. V. Nakov, "Prevalence of small intestinal bacterial overgrowth in patients with liver cirrhosis." Journal of Gastroenterology and Hepatology Research, vol. 212 (8), pp. 740-743, 2015.
[11]	H. Salem, M. Mansour, A. Elsaady, M. Mohsen, K. Mansour, "Relation between fecal calprotectin concentration and severity of Hepatitis C related chronic liver disease." Int. J. Adv. Res. Biol. Sci., vol. 2 (7), pp. 115-125, 2015.

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APA Style

Inas Elkhedr Mohamed, Fatma Ahmed Ali-Eldin. (2017). Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy. International Journal of Clinical and Experimental Medical Sciences, 3(6), 82-86. https://doi.org/10.11648/j.ijcems.20170306.14

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ACS Style

Inas Elkhedr Mohamed; Fatma Ahmed Ali-Eldin. Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy. Int. J. Clin. Exp. Med. Sci. 2017, 3(6), 82-86. doi: 10.11648/j.ijcems.20170306.14

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AMA Style

Inas Elkhedr Mohamed, Fatma Ahmed Ali-Eldin. Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy. Int J Clin Exp Med Sci. 2017;3(6):82-86. doi: 10.11648/j.ijcems.20170306.14

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@article{10.11648/j.ijcems.20170306.14,
  author = {Inas Elkhedr Mohamed and Fatma Ahmed Ali-Eldin},
  title = {Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {3},
  number = {6},
  pages = {82-86},
  doi = {10.11648/j.ijcems.20170306.14},
  url = {https://doi.org/10.11648/j.ijcems.20170306.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20170306.14},
  abstract = {Fecal calprotectin is considered a valid marker of intestinal inflammation and its high level in patients with HE may be explained by small intestinal bacterial overgrowth. This study aimed to assess the role of fecal calprotectin in diagnosis and follow up of patients with hepatic encephalopathy. Fifteen patients with uncomplicated liver cirrhosis, 30 patients with liver cirrhosis complicated by hepatic encephalopathy (HE) and 15 healthy subjects were enrolled. All participants were subjected to: clinical examination, laboratory investigations (CBC, liver function tests, kidney functions, HBs Ag and HCV Antibody), fecal calprotectin concentration, abdominal ultrasound. Severity of HE was assessed according to West–Haven criteria. Patients with HE was managed using metronidazole and rifaximin and fecal calprotectin concentrations were reassessed. The level of fecal calprotectin is significantly higher in patients with Child-Pugh class B (116±12 mg/kg) versus that in class A (66±15 mg/kg) (p<0.01). FC concentrations showed the lowest value in the cirrhotic group (66+15 mg/kg) followed by low grade HE (195+12mg/kg) and the highest value in the high grade HE group (489+23mg/kg) (p<0.01). A significant decrease in FC concentrations occurred in HE group after receiving treatment, reaching a level of 273+42.68 mg/kg versus 364+83.12 mg/kg before rifaximin. In conclusion: Fecal calprotectin can be used in diagnosis of HE. Significant high levels of fecal calprotectin in high grade HE patients and its reduction following effective treatment could consider fecal calprotectin as a follow up marker in association with clinical signs in patients with HE.},
 year = {2017}
}

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TY  - JOUR
T1  - Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy
AU  - Inas Elkhedr Mohamed
AU  - Fatma Ahmed Ali-Eldin
Y1  - 2017/12/05
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcems.20170306.14
DO  - 10.11648/j.ijcems.20170306.14
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 82
EP  - 86
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20170306.14
AB  - Fecal calprotectin is considered a valid marker of intestinal inflammation and its high level in patients with HE may be explained by small intestinal bacterial overgrowth. This study aimed to assess the role of fecal calprotectin in diagnosis and follow up of patients with hepatic encephalopathy. Fifteen patients with uncomplicated liver cirrhosis, 30 patients with liver cirrhosis complicated by hepatic encephalopathy (HE) and 15 healthy subjects were enrolled. All participants were subjected to: clinical examination, laboratory investigations (CBC, liver function tests, kidney functions, HBs Ag and HCV Antibody), fecal calprotectin concentration, abdominal ultrasound. Severity of HE was assessed according to West–Haven criteria. Patients with HE was managed using metronidazole and rifaximin and fecal calprotectin concentrations were reassessed. The level of fecal calprotectin is significantly higher in patients with Child-Pugh class B (116±12 mg/kg) versus that in class A (66±15 mg/kg) (p<0.01). FC concentrations showed the lowest value in the cirrhotic group (66+15 mg/kg) followed by low grade HE (195+12mg/kg) and the highest value in the high grade HE group (489+23mg/kg) (p<0.01). A significant decrease in FC concentrations occurred in HE group after receiving treatment, reaching a level of 273+42.68 mg/kg versus 364+83.12 mg/kg before rifaximin. In conclusion: Fecal calprotectin can be used in diagnosis of HE. Significant high levels of fecal calprotectin in high grade HE patients and its reduction following effective treatment could consider fecal calprotectin as a follow up marker in association with clinical signs in patients with HE.
VL  - 3
IS  - 6
ER  -

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Author Information

Inas Elkhedr Mohamed

Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Fatma Ahmed Ali-Eldin

Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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APA Style

Inas Elkhedr Mohamed, Fatma Ahmed Ali-Eldin. (2017). Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy. International Journal of Clinical and Experimental Medical Sciences, 3(6), 82-86. https://doi.org/10.11648/j.ijcems.20170306.14

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ACS Style

Inas Elkhedr Mohamed; Fatma Ahmed Ali-Eldin. Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy. Int. J. Clin. Exp. Med. Sci. 2017, 3(6), 82-86. doi: 10.11648/j.ijcems.20170306.14

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AMA Style

Inas Elkhedr Mohamed, Fatma Ahmed Ali-Eldin. Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy. Int J Clin Exp Med Sci. 2017;3(6):82-86. doi: 10.11648/j.ijcems.20170306.14

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@article{10.11648/j.ijcems.20170306.14,
  author = {Inas Elkhedr Mohamed and Fatma Ahmed Ali-Eldin},
  title = {Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {3},
  number = {6},
  pages = {82-86},
  doi = {10.11648/j.ijcems.20170306.14},
  url = {https://doi.org/10.11648/j.ijcems.20170306.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20170306.14},
  abstract = {Fecal calprotectin is considered a valid marker of intestinal inflammation and its high level in patients with HE may be explained by small intestinal bacterial overgrowth. This study aimed to assess the role of fecal calprotectin in diagnosis and follow up of patients with hepatic encephalopathy. Fifteen patients with uncomplicated liver cirrhosis, 30 patients with liver cirrhosis complicated by hepatic encephalopathy (HE) and 15 healthy subjects were enrolled. All participants were subjected to: clinical examination, laboratory investigations (CBC, liver function tests, kidney functions, HBs Ag and HCV Antibody), fecal calprotectin concentration, abdominal ultrasound. Severity of HE was assessed according to West–Haven criteria. Patients with HE was managed using metronidazole and rifaximin and fecal calprotectin concentrations were reassessed. The level of fecal calprotectin is significantly higher in patients with Child-Pugh class B (116±12 mg/kg) versus that in class A (66±15 mg/kg) (p<0.01). FC concentrations showed the lowest value in the cirrhotic group (66+15 mg/kg) followed by low grade HE (195+12mg/kg) and the highest value in the high grade HE group (489+23mg/kg) (p<0.01). A significant decrease in FC concentrations occurred in HE group after receiving treatment, reaching a level of 273+42.68 mg/kg versus 364+83.12 mg/kg before rifaximin. In conclusion: Fecal calprotectin can be used in diagnosis of HE. Significant high levels of fecal calprotectin in high grade HE patients and its reduction following effective treatment could consider fecal calprotectin as a follow up marker in association with clinical signs in patients with HE.},
 year = {2017}
}

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TY  - JOUR
T1  - Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy
AU  - Inas Elkhedr Mohamed
AU  - Fatma Ahmed Ali-Eldin
Y1  - 2017/12/05
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcems.20170306.14
DO  - 10.11648/j.ijcems.20170306.14
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 82
EP  - 86
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20170306.14
AB  - Fecal calprotectin is considered a valid marker of intestinal inflammation and its high level in patients with HE may be explained by small intestinal bacterial overgrowth. This study aimed to assess the role of fecal calprotectin in diagnosis and follow up of patients with hepatic encephalopathy. Fifteen patients with uncomplicated liver cirrhosis, 30 patients with liver cirrhosis complicated by hepatic encephalopathy (HE) and 15 healthy subjects were enrolled. All participants were subjected to: clinical examination, laboratory investigations (CBC, liver function tests, kidney functions, HBs Ag and HCV Antibody), fecal calprotectin concentration, abdominal ultrasound. Severity of HE was assessed according to West–Haven criteria. Patients with HE was managed using metronidazole and rifaximin and fecal calprotectin concentrations were reassessed. The level of fecal calprotectin is significantly higher in patients with Child-Pugh class B (116±12 mg/kg) versus that in class A (66±15 mg/kg) (p<0.01). FC concentrations showed the lowest value in the cirrhotic group (66+15 mg/kg) followed by low grade HE (195+12mg/kg) and the highest value in the high grade HE group (489+23mg/kg) (p<0.01). A significant decrease in FC concentrations occurred in HE group after receiving treatment, reaching a level of 273+42.68 mg/kg versus 364+83.12 mg/kg before rifaximin. In conclusion: Fecal calprotectin can be used in diagnosis of HE. Significant high levels of fecal calprotectin in high grade HE patients and its reduction following effective treatment could consider fecal calprotectin as a follow up marker in association with clinical signs in patients with HE.
VL  - 3
IS  - 6
ER  -

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