***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : Fecal calprotectin concentration in stool has recently been proposed as a marker of colonic neoplasm and inflammation , but the intraindividual day-to-day variability has so far received little attention . The present study was undertaken to determine the biological variability of fecal calprotectin in patients referred for colonoscopy . METHODS : A prospect i ve design was applied . In each of 14 consecutive patients su bmi tted for colonoscopy  , eight stool sample s were collected before the endoscopy . A detailed question naire was used .  Calprotectin  was measured by quantitative enzyme-linked immunoassay , and st and ard deviation for the within-patient variability was estimated from one-way analysis of variance . RESULTS : In absence of colonic neoplasm and inflammation , two population s of patients emerged : one ( 36 % ) with remarkably low and stable fecal calprotectin values all within the recommended cut-off of 50 μg/g , and one ( 64 % ) with labile values also beyond this limit . In this latter group , fecal calprotectin was 70 μg/g ( mean ) ( single tests ranged from 9 to 461 ) , and SD within patients was 52 μg/g , showing considerable day-to-day variation . History , concurrent diseases , or findings at colonoscopy could not explain labile values . A similar pattern was observed for spot variation in one stool sample from healthy volunteers , suggesting that factors other than disease contribute to the significant intraindividual biological variation of fecal calprotectin . CONCLUSIONS : Day-to-day variation of fecal calprotectin is considerable in patients without colonic inflammation or neoplasm , for whom the pattern of stabile low fecal calprotectin may seem to be a valid negative predictor . The origin and pattern of fecal calprotectin excretion deserve further attention BACKGROUND The diagnosis of non-steroidal anti-inflammatory drug ( NSAID ) induced enteropathy is difficult , requiring enteroscopy or the use of four day faecal excretion of 111In labelled white cells . AIMS To assess faecal calprotectin ( a non-de grade d neutrophil cytosolic protein ) as a method for diagnosing NSAID enteropathy . METHODS Single stool  faecal calprotectin concentrations were compared with the four day faecal excretion of 111In labelled white cells in 47 patients taking NSAIDs .  The prevalence and severity of NSAID enteropathy was assessed using this method in 312 patients ( 192 with rheumatoid arthritis , 65 with osteoarthritis , 55 with other conditions ) taking 18 different NSAIDs .  RESULTS The four day faecal excretion of 111In white cells correlated significantly with faecal calprotectin concentrations . In the group of 312 patients on NSAIDs faecal calprotectin concentrations were significantly higher than in controls , the prevalence of NSAID enteropathy being 44 % . The prevalence and severity of NSAID enteropathy was independent of the particular type or dose of NSAID being taken or other patient variables . CONCLUSIONS Assay of faecal calprotectin  provides a simple practical method for diagnosing NSAID enteropathy in man . Forty four per cent of patients receiving these drugs had NSAID induced enteropathy when assessed by this technique ; 20 % of these had comparable levels of inflammation to that previously reported in patients with inflammatory bowel disease Background : Calprotectin , a major component of soluble cytosolic proteins in human neutrophil granulocytes , is excreted in excess in stools during inflammatory bowel disease in adults and children .  Faecal calprotectin concentrations are also higher during the first year of life than in adults . Objectives : To measure faecal calprotectin concentrations in the neonatal period and define reference values according to the mode of feeding : st and ard infant formula , prebiotic infant formula ( Calisma , Blédina SA , France ) , or breast feeding . Patients and methods : A prospect i ve study was carried out over three months in 69 full term , healthy newborns with a median gestational age of 39.8 weeks ( range 37–41.5 ) and a birth weight of 3300 g ( range 2600–4460 ) . Three groups were formed depending on the mode of feeding : group 1 ( n = 18 ) received a st and ard infant formula , group 2 ( n = 19 ) the prebiotic infant formula , and group 3 ( n = 32 ) was breast fed . One stool sample was taken from each newborn on day 4 ( 3–7 ) , and faecal calprotectin analysed using a commercial enzyme linked immunoassay ( Calprest , Eurospital , Italy ) . Results : Faecal calprotectin concentrations ( median 167 µg/g ) were higher than reference values in healthy adults . The concentration was below the upper reference limit for adults ( 50 µg/g ) for three infants only , one fed the st and ard formula and two fed the prebiotic formula . Concentrations did not differ significantly according to method of feeding . Conclusions : Compared with healthy adults , newborns have high calprotectin concentrations in the first days of life . There is no obvious influence of the mode of feeding The mucosa of the pelvic ileal reservoir undergoes adaptive changes -- inflammatory , architectural , and metaplastic -- on exposure to the faecal stream . Twenty three quadruple loop ileal pouches constructed for ulcerative colitis ( 20 patients ) and familial adenomatous polyposis ( FAP ) ( three patients ) were studied . No patient fulfilled clinical , endoscopic , or histopathological criteria for pouchitis .  St and ard duplicate biopsy specimens were taken from the proximal limb , the anterior wall , the posterior wall , and the body of the reservoir . An established scoring system was used and showed a highly significant increase in inflammatory scores in posterior wall biopsy specimens compared with those from the anterior wall . These results suggest that the adaptive changes are the direct result of contact with static faecal contents . One patient only showed significant inflammation in the proximal limb . There was no evidence of mucosal prolapse in any anterior wall biopsy specimen . Patients with colitis showed substantially more inflammatory and architectural changes than those with FAP . Ninety six per cent of pouches showed some colonic phenotypic expression as defined by mucin histochemical and PR 3A5 immunohistochemical studies . Our results suggest , however , that there may not be complete colonic metaplasia and that the mucin changes and other phenotypic alterations may represent a non-specific response to pouch inflammation and not a prerequisite for the development of pouchitis . The focal nature of the inflammatory and architectural changes , which may be the result of direct contact with static faecal residue , are clearly shown . A single r and om biopsy specimen of pouch mucosa is of limited value in assessing pathological changes and screening for potential neoplastic change within the reservoir Backgound : Patients being investigated for symptoms of abdominal pain , diarrhoea and or weight loss  often undergo small bowel radiology as part of their diagnostic workup mainly to exclude inflammatory bowel disease OBJECTIVES : Stool testing is a well established method of screening for colorectal neoplasia . Emerging data suggest that novel biomarkers may offer performance advantages over fecal occult blood . In this large , prospect i ve study , we assessed fecal calprotectin ( a leukocyte-derived protein ) as a screening biomarker for colorectal neoplasia . Fecal calprotectin was directly compared to fecal hemoglobin ( Hb ) and colonoscopy as the existing criterion st and ards for stool screening and structural evaluation , respectively . METHODS : Subjects included colonoscopy patients with a personal history of colorectal neoplasia , family history of colorectal cancer , or iron deficiency anemia . Stool specimens were collected before purgation , processed appropriately , and quantitatively analyzed for calprotectin ( Nycomed Pharma , Oslo , Norway ) and for Hb ( Mayo Medical Laboratories , Rochester , MN ) by masked technicians . Colonoscopies were performed by experienced endoscopists without prior knowledge of the fecal assay results . RESULTS : Among 412 subjects , 97 ( 24 % ) subjects had one or more colorectal neoplasms ( including three with adenocarcinomas ) .  Fecal calprotectin levels did not differ significantly between subjects with versus subjects without colorectal neoplasms ( p= 0.33 ) . Neither tumor number ( p= 0.85 ) nor tumor size ( p= 0.86 ) significantly influenced the observed fecal calprotectin concentrations . Estimates of the sensitivity , specificity , and positive and negative predictive values of fecal calprotectin for any colorectal neoplasms were 37 % , 63 % , 23 % , and 76 % , respectively . Comparable performance estimates for fecal Hb were 3 % , 97 % , 27 % , and 77 % , respectively . CONCLUSIONS : In this cohort of colonoscopy patients at above average risk , fecal calprotectin was a poor screening biomarker for colorectal neoplasia . Further investigation of tumor-derived , rather than blood-based , biomarkers may be a more rewarding approach to stool screening for colorectal neoplasia Background : Screening for colorectal cancer ( CRC ) using guaiac based faecal occult blood tests ( FOBT ) has an estimated programme sensitivity of > 60 % but < 30 % for strictly asymptomatic CRC in a single screening round . In search for improved non-invasive tests for screening , we compared a test for faecal calprotectin ( PhiCal ) with a human haemoglobin immunochemical FOBT ( FlexSure OBT ) . Methods : In the Norwegian Colorectal Cancer Prevention ( NORCCAP ) trial , screenees in one screening arm were offered screening with combined flexible sigmoidoscopy ( FS ) and FlexSure OBT . They were also requested to bring a fresh frozen sample of stool for the PhiCal test which was performed on sample s from screenees with CRC ( n = 16 ) , high risk adenoma ( n = 195 ) , low risk adenoma ( n = 592 ) , and no adenoma ( n = 1518 ) ( 2321 screenees in total ) . A positive PhiCal test was defined by a calprotectin level ⩾50 μg/g . Results : The PhiCal test was positive in 24–27 % of screenees whether they had no adenoma , low risk adenoma , or high risk adenoma . Ten ( 63 % ) of 16 CRCs gave a positive PhiCal test . The total positivity rate in this population was 25 % for the PhiCal test compared with 12 % for FlexSure OBT , with a sensitivity for advanced neoplasia of 27 % and 35 % , respectively . Specificity for “ any neoplasia ” was 76 % for the PhiCal test and 90 % for FlexSure OBT . Conclusions : In colorectal screening , the performance of the PhiCal test on a single spot from one stool sample was poorer than a single screening round with FlexSure OBT and can not be recommended for population screening purpose s. The findings indicate a place for FlexSure OBT in FOBT screening The Pediatric Crohn 's Disease Activity Index ( PCDAI ) has been proposed as a simple instrument to aid in the classification of patients by disease severity . The PCDAI includes subjective patient reporting of symptoms , physical examination , nutritional parameters , and several common laboratory tests ( hematocrit , erythrocyte sedimentation rate , albumin ) . In this report we examine the relationship of each of the laboratory parameters to the PCDAI , as well as to a modified Harvey-Bradshaw Index score and physician global assessment of disease activity . Data were gathered from the clinical and laboratory observations from 133 children and adolescents at 12 pediatric gastroenterology centers in North America . A statistically significant relationship ( p < 0.05 ) was noted between each of the laboratory tests and the PCDAI for patients with either disease limited to the small bowel or in those with colonic in volvement . For patients with disease limited to the small bowel , a statistically significant ( p < 0.05 ) relationship was also noted between the three laboratory parameters and the modified Harvey-Bradshaw Index and global assessment . For patients with large-bowel involvement , the erythrocyte sedimentation rate was statistically related to the modified Harvey-Bradshaw Index and global assessment ( p < 0.01 ) , as was hematocrit to global assessment ( p < 0.01 ) . Although the laboratory parameters used in the PCDAI appear to generally reflect disease activity in most patients , no single laboratory test is adequate to reflect disease activity in all patients . Future work will need to identify additional laboratory measures to reflect the inflammatory process and serve as important adjuncts in the assessment of disease activity BACKGROUND AND AIMS Assessing the presence and degree of intestinal inflammation objective ly , simply , and reliably is a significant problem in gastroenterology . We assessed faecal excretion of calprotectin  , a stable neutrophil specific marker , as an index of intestinal inflammation and its potential use as a screening test to discriminate between patients with Crohn 's disease and those with irritable 
    Output:
    
Fecal calprotectin correlates well with histological inflammation as detected by colonoscopy with biopsies and has been shown successfully to predict relapses and detect pouchitis in patients with IBD .
Fecal calprotectin has been shown to consistently differentiate IBD from irritable bowel syndrome because it has excellent negative predictive value in ruling out IBD in undiagnosed , symptomatic patients .
Fecal calprotectin  also may be useful in determining whether clinical symptoms in patients with known IBD are caused by disease flares or noninflammatory complications/underlying irritable bowel syndrome and in providing objective evidence of response to treatment .