Fecal calprotectin in Celiac children at diagnosis and on gluten-free diet: a pilot study

Introduction: Calprotectin is a neutrophil antimicrobial protein released during inflammation. Fecal calprotectin (FC) is an inflammatory mucosal biomarker used to distinguish between organic and functional gastrointestinal disease. The aim of this study was to estimate the prevalence of abnormal FC values in Celiac disease (CD). Methods: A stool sample was collected from 16 children (mean age: 5.8 years) at the time of diagnosis of CD and after 6 months of gluten free diet. Values for FC were considered abnormal when: >910 g/g of stool between 0–12 months of age; >286 g/g of stool between 1–4 years and >54 g/g of stool at age greater than 4 years (Roca, J Pediatr Gastroenterol Nutr 2017;65(4):394–8). Results: At diagnosis 3 patients were asymptomatic and 7 had gastrointestinal symptoms; 9 were diagnosed without small bowel biopsy according to ESPGHAN guidelines. Seven out of 16 patients had an abnormal value of FC (median of 75 g/g of stool, range 5–688); of these 4 had gastrointestinal symptoms. Two out of 7 children with small bowel lesions showed an abnormal value FC, both had a IIIc lesion according to Marsh. Patients with abnormal value FC had an anti-TTGA titre higher than patients with a normal FC level. After 6 months gluten free, all patient reduced FC levels (median FC value 28 g/g of stool, range 3.8–242) and the antibody titre. Only one patient had still abnormal FC value together with higher anti-transglutaminase titre when compared to the other patients. Conclusions: Increased fecal calprotectin concentration could be used as a non-invasive biomarker in the diagnosis of Celiac disease, especially in patients with gastrointestinal symptoms. Fecal calprotectin concentration returns to normal after a strict gluten- free diet. Fecal calprotectin might be used as a marker of diet adherence and improvement in gastrointestinal lesions in children with Celiac disease.