Background

A significant limitation of mucosal healing as a treatment target in Crohn's disease is that Ileocolonoscopy remains the gold-standard for assessing disease activity. Identifying optimal biomarkers and their cut-off values is an unmet need in the context of tight monitoring strategy.



Aim

To study the performance of Fecal lactoferrin (FL) in patients with Crohn's disease in comparison to endoscopic assessment, clinical indices and fecal calprotectin (FC) to address whether it correlates with endoscopic severity of inflammation and whether it could be used as a surrogate marker of mucosal healing after therapy.



Methods

In this prospective study, 35 patients with active Crohn's disease were recruited.

All patients provided stool samples for FL and FC at baseline and underwent colonsocopy. 26 of these patients were followed up after 6-9 months of therapy initiation or upgrade. FL was compared with the simple endoscopic score of Crohn's disease (SES-CD) ,Harvey-Bradshaw index (HBI) and FC. Data was analyzed to identify cut-off levels for endoscopic response/remission.



Results

Lactoferrin showed excellent performance in detecting remission (AUC 0.93) with a sensitivity of 85.7% and a specificity of 88.9% at a cut-off of 21.5µg/g. A drop of >26.2% from baseline values is 100% sensitive and specific in detecting endoscopic response (≥50% reduction from baseline SES-CD). Lactoferrin showed strong correlation with SES-CD (r=0.74) and calprotectin (r=0.91)



Conclusion

FL is a reliable marker of response to therapy and mucosal healing, making endoscopic monitoring of treatment success less necessary. Whether Lactoferrin is superior to Calprotectin or not would require further investigation.