Clinical implications of the determination of fecal calprotectin in children with celiac disease: A cross-sectional study

Background. A promising research avenue in recent years has been implementing research findings on biological markers of inflammation into clinical practice. One such marker is fecal calprotectin. The literature contains only isolated reports on fecal calprotectin concentrations in patients with celiac disease, and the available data vary significantly.

Objective. To determine the clinical significance of fecal calprotectin in pediatric celiac disease and to find its relationship with small bowel permeability.

Materials and methods. From January 2018 to June 2019, 42 pediatric patients were examined: 28 with newly diagnosed celiac disease, 14 previously diagnosed children adhering to a gluten-free diet, and 20 apparently healthy, age-matched control subjects. All participants were tested for IgA tissue transglutaminase antibodies and for total IgA (ELISA). Fecal calprotectin levels were also measured using ELISA. Intestinal permeability was assessed using a non-invasive method (after Petrov V.I. et al., 2003).

Results. Fecal calprotectin levels were elevated in newly diagnosed celiac patients (36.6 ± 10.2 мcg/g) compared with the control group (20.9 ± 8.7 мcg/g). In children with refractory celiac disease, fecal calprotectin levels were significantly higher than in both the newly diagnosed group and controls (77.9 ± 24 мcg/g). Assessment of the intestinal barrier showed increased intestinal permeability in celiac patients compared with healthy controls (0.3 ± 0.02 optical units, p < 0.05), with the most pronounced changes observed in newly diagnosed patients (–0.1 ± 0.05 optical units). Correlation analysis revealed a strong positive relationship between fecal calprotectin levels and small bowel permeability in refractory celiac disease (r = 0.96).

Conclusion. In children with refractory celiac disease, fecal calprotectin levels exceed those of both healthy controls and newly diagnosed patients. A strong correlation was identified between elevated fecal calprotectin values and increased intestinal per- meability in children with refractory celiac disease.

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