***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: BACKGROUND & AIMS Histologic recovery of patients with ulcerative colitis ( UC ) often is incomplete , even among those in clinical and endoscopic remission . Persistent active microscopic inflammation is associated with an increased risk of relapse and colorectal neoplasia . A high level of  fecal calprotectin ( FC )  is a reliable marker of endoscopic lesions in patients with UC . We evaluated the accuracy of FC in identifying patients with UC in clinical and endoscopic remission who still have histologic features of inflammation . METHODS We performed a prospect i ve observational study of 59 patients with UC in clinical and endoscopic remission undergoing colonoscopy .  Several biopsy specimens were collected from each colonic segment . Endoscopic remission was defined as a Mayo endoscopic subscore with a grade of 0 or 1 . Active histologic inflammation was defined by the presence of neutrophils infiltrating crypt epithelial cells . FC was determined by enzyme-linked immunosorbent assay analysis . RESULTS Eighteen patients ( 30.5 % ) showed evidence of active histologic inflammation . Patients with active histologic inflammation had a significantly higher median level of FC ( 278 μg/g ; interquartile range , 136 - 696 μg/g ) than those without active histologic inflammation ( 68 μg/g ; interquartile range , 30 - 172 μg/g ) ( P = .002 ) . In multivariate analysis , the FC and Mayo endoscopic subscore ( 0 or 1 ) were each independent predictors of histologic inflammation . The level of FC identified active histologic inflammation in patients in clinical and endoscopic remission , with an area under the receiver operator characteristic curve value of 0.754 . CONCLUSIONS Histologic inflammation is common among patients with UC in clinical and endoscopic remission . Patients with histologic features of inflammation can be identified reliably based on their fecal level of calprotectin Background The aim of this study is to compare two methods for measuring fecal calprotectin ( FC ) concentration and to evaluate the possibility of differentiation between microscopic colitis ( MC ) and irritable bowel syndrome ( IBS ) . Methods Twenty-three patients with MC ( six patients with active disease and 17 patients retested in remission ) and 20 patients with IBS were prospect ively included in this study . Active disease state of MC was determined by clinical symptoms of > 3 bowel movements per day and histological correlate . All patients underwent ileocolonoscopy  , including segmental biopsy sample s for histology . FC levels in stool sample s were analyzed using a rapid test system ( Quantum Blue ® ) and an enzyme-linked immunosorbent assay ( ELISA ) . Results FC levels were significantly higher in patients with active MC ( median 48 μg/g [ 23–106 ] ) compared to patients with IBS ( median 2 μg/g [ 1–111.83 ] ) , P=0.0001 using an ELISA . FC level of patients with MC in remission was 22 μg/g ( 1–106.4 ) , which is similar to those identified in patients with IBS . The difference of FC levels between active MC and IBS was not detected by the FC rapid test ( P=0.635 ) . Discussion FC levels might serve as parameter for differentiation between patients with active MC and IBS . Since there is no surrogate marker available at present for MC , FC appears to be a c and i date for differentiating MC from IBS . Conclusion High FC levels , which were analyzed by ELISA , are a potential marker for patients with active MC compared to those with IBS . The FC rapid test was less suitable for this purpose 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 : Noninvasive biomarkers of inflammation for monitoring inflammatory bowel disease ( IBD ) are important in pregnancy . Clinical and laboratory markers are often affected by the physiological adaption that occurs during pregnancy , although , few , if any , data exist on fecal calprotectin ( FC ) . We investigated FC concentrations in pregnant controls and IBD women , and whether FC correlated with physician global assessment ( PGA ) , C-reactive protein ( CRP ) , and Harvey – Bradshaw Index (HBI)/Simple Clinical Colitis Activity Index ( SCCAI ) before and after pregnancy , as well as during each trimester . Methods : The study is a prospect i ve multicenter study of 46 pregnant women with and 21 without IBD in Denmark , Australia , and New Zeal and . Demographics , clinical parameters , and HBI/SCCAI were recorded .  Stool and blood sample s were obtained to determine  FC and CRP concentrations . Results : From pregnant IBD women and pregnant controls , 174 and 21 fecal sample s were collected , respectively . The median FC concentration in pregnant IBD women was 131 & mgr;g/g ( range 0–3600 ) and in controls 0 & mgr;g/g ( range 0–84 ) ( P < 0.0001 ) . FC strongly correlated with PGA at all 5 timepoints ( r ≥ 0.80 ; P < 0.0001 ) and with HBI/SCCAI before ( r = 0.66 ; P < 0.0001 ) and after pregnancy ( r = 0.47 ; P < 0.003 ) but not during pregnancy ( P > 0.05 ) . An FC cutoff concentration of 250 & mgr;g/g significantly correlated with active disease according to PGA in all 5 periods ( P ⩽ 0.0002 ) . CRP only significantly correlated with FC ( P = 0.0007 ) and PGA in the second trimester ( P = 0.0003 ) . No significant correlation was found between CRP and HBI/SCCAI at any timepoint ( P > 0.05 ) . Conclusions : The physiological changes that occur during pregnancy do not affect FC , in contrast to CRP and HBI/SCCAI . The combined use of FC and PGA seems optimal to assess disease activity in IBD during pregnancy BACKGROUND / AIMS Noninvasive activity markers are extremely important in conditions , such as pregnancy , when endoscopy is not recommended . The aim of this prospect i ve study was to determine fecal calprotectin ( FC ) concentrations in healthy non-pregnant and pregnant women and in patients with inflammatory bowel disease ( IBD ) . MATERIAL S AND METHODS Healthy pregnant and non-pregnant women and patients with active and inactive IBD were prospect ively enrolled in this study . Demographic and clinical parameters and clinical disease activity scores in patients with IBD were recorded . Blood and stool sample s of every patient were obtained to determine C-reactive protein and FC levels . FC levels were measured with a quantitative lateral flow assay . RESULTS One hundred and thirty-five subjects were enrolled in the study ( 24 non-pregnant and 48 pregnant healthy women , 40 non-pregnant patients with active IBD and 23 non-pregnant patients with inactive IBD ) .  FC was significantly higher in active IBD patients than in pregnant ( p<0.001 ) and non-pregnant healthy women ( p<0.001 ) . No difference could be detected in FC concentrations between pregnant and non-pregnant healthy women . CONCLUSION Since FC levels remained unchanged during pregnancy , it may be a useful noninvasive diagnostic tool in pregnancy for monitoring mucosal inflammation Background : This study examined whether fecal calprotectin can be used in daily practice as a marker to monitor patients with ulcerative colitis ( UC ) receiving infliximab maintenance therapy . Methods : This prospect i ve multicenter study enrolled adult patients with UC in clinical remission under infliximab maintenance therapy .  Fecal calprotectin levels were measured every 4 weeks . Sigmoidoscopies were performed at inclusion and at study end . Relapse was defined as a clinical need for change in treatment or an endoscopic Mayo subscore of ≥2 at week 52 . Sustained deep remission was defined as a partial Mayo score <3 at all points and an endoscopic Mayo score 0 at week 52 . Results : Full analysis was possible for 87 of 113 included patients with UC ( 77 % ) . Of these patients , 30 ( 34.4 % ) were considered to be in sustained deep remission and 13 ( 14.9 % ) to have relapsed . Calprotectin levels in patients with sustained deep remission remained very low ( median < 40 mg/kg at all time points ) . Patients who flared had significantly higher calprotectin levels ( median > 300 mg/kg ) already 3 months before the flare . Further receiver operator curve analysis suggested that a calprotectin level > 300 mg/kg had a reasonable sensitivity ( 58.3 % ) and specificity ( 93.3 % ) to model flare . Two consecutive calprotectin measurements of > 300 mg/kg with 1-month interval were identified as the best predictor of flare ( 61.5 % sensitivity and 100 % specificity ) . Conclusions : Fecal calprotectin can be used in daily practice to monitor patients with UC receiving infliximab maintenance therapy . Two consecutive measurements > 300 mg/kg is more specific than a single measurement for predicting relapse BACKGROUND Most patients with Crohn 's disease need an intestinal resection , but a majority will subsequently experience disease recurrence and require further surgery . This study aim ed to identify the optimal strategy to prevent postoperative disease recurrence . METHODS In this r and omised trial , consecutive patients from 17 centres in Australia and New Zeal and undergoing intestinal resection of all macroscopic Crohn 's disease , with an endoscopically accessible anastomosis , received 3 months of metronidazole therapy . Patients at high risk of recurrence also received a thiopurine , or adalimumab if they were intolerant to thiopurines . Patients were r and omly assigned to parallel groups : colonoscopy at 6 months ( active care ) or no colonoscopy ( st and ard care ) . We used computer-generated block r and omisation to allocate patients in each centre to active or st and ard care in a 2:1 ratio . For endoscopic recurrence ( Rutgeerts score ≥i2 ) at 6 months , patients stepped-up to thiopurine , fortnightly adalimumab with thiopurine , or weekly adalimumab . The primary endpoint was endoscopic recurrence at 18 months . Patients and treating physicians were aware of the patient 's study group and treatment , but central reading of the endoscopic findings was undertaken blind to the study group and treatment . Analysis included all patients who received at least one dose of study drug . This trial is registered with Clinical Trials.gov , number NCT00989560 . FINDINGS Between Oct 13 , 2009 , and Sept 28 , 2011 , 174 ( 83 % high risk across both active and st and ard care groups ) patients were enrolled and received at least one dose of study drug . Of 122 patients in the active care group , 47 ( 39 % ) stepped-up treatment . At 18 months , endoscopic recurrence occurred in 60 ( 49 % ) patients in the active care group and 35 ( 67 % ) patients in the st and ard care group ( p=0.03 ) . Complete mucosal normality was maintained in 27 ( 22 % ) of 122 patients in the active care group versus four ( 8 % ) in the st and ard care group ( p=0.03 ) . In the active care arm , of those with 6 months recurrence who stepped up treatment , 18 ( 38 % ) of 47 patients were in remission 12 months later ; conversely , of those in remission at 6 months who did not change therapy recurrence occurred in 31 ( 41 % ) of 75 patients 12 months later . Smoking ( odds ratio [ 
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Most of these were focused on the use of FCAL in IBD diagnosis and showed a relevant role for this marker in selecting patients with gastrointestinal symptoms who would not need a further examination by endoscopy .
Although a lesser number of meta-analyses have been performed on the use of FCAL as a surrogate marker of disease activity , a close correlation between FCAL and endoscopic activity of IBD has been shown .
With respect to the predictive capacity of FCAL for IBD relapse , a single meta- analysis published indicates that this role is more limited .