Volume 3, Issue 6, November 2017, Page: 82-86
Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy
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
Received: Feb. 26, 2017;       Accepted: Mar. 24, 2017;       Published: Dec. 5, 2017
DOI: 10.11648/j.ijcems.20170306.14      View  3180      Downloads  151
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.
Fecal Calprotectin, Liver Cirrhosis, Hepatic Encephalopathy
To cite this article
Inas Elkhedr Mohamed, Fatma Ahmed Ali-Eldin, Role of Fecal Calprotectin in Diagnosis and Follow up of Hepatic Encephalopathy, International Journal of Clinical and Experimental Medical Sciences. Vol. 3, No. 6, 2017, pp. 82-86. doi: 10.11648/j.ijcems.20170306.14
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
K. Gyr, R. Meier, "Flumazenil in the treatment of portal systemic encephalopathy-an overview,". Intens. Care. Med., vol. 17, pp. S39-S42, 1991.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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