COMBINED ESTIMATION OF FECAL CALPROTECTIN AND M2-PK FOR DIFFERENTIATION OF PATIENTS WITH QUERY INFLAMMATORY BOWEL DISEASE
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Objectives: To evaluate the diagnostic utility of estimating fecal calprotectin (FC) and fecal tumor M2 pyruvate kinase (F-M2PK) levels for differentiation among cases having chronic symptoms suggestive of inflammatory bowel diseases (IBD). Patients & Methods: The study included 26 ulcerative colitis patients (UC group), 26 patients diagnosed as irritable bowel syndrome (IBS group) and 13 patients had pathologically confirmed colorectal carcinoma (Cancer group). Control group included 25 apparently healthy volunteers without significant GIT manifestations. Patients with UC were evaluated using Harvey—Bradshaw Activity Index for UC, colonoscopic examination and mucosal biopsy. Patients with suspected IBS were evaluated according to the Rome-I criteria; the IBS activity index was evaluated using IBS symptom questionnaire and then patients underwent sigmoidoscopy with biopsy. All study participants (patients & controls) supplied fresh fecal samples that were processed for ELISA estimation of FC and FM2PK. Results: Sixteen patients had active UC (activity score=7.3±1.6) and 9 patients had active IBS (activity score=12.7±1.2). Estimated fecal levels of FC and F-M2PK were significantly higher in UC group compared to control and IBS groups, whereas, IBS group patients had significantly higher FC levels, but non-significantly higher F-M2FIC levels, compared to controls. Active UC patients had significantly higher levels of FC and F-M2PK compared to those had quiescent UC, while active IBS patients had significantly higher F-M2131( levels, but non-significantly higher FC levels, compared to patients had quiescent IBS. Estimated fecal levels of FC and F-M2PK in cancer patients were significantly higher compared to both control and IBS groups, with significantly lower FC and significant higher F-M2PK levels compared to UC group. Conclusion: Combined estimation of FC and F-M2PK levels could be used for screening patients with gastrointestinal manifestations suggestive of IBD, where higher levels of FC could differentiate among IBD, colorectal cancer and IBS patients and could differentiate IBS patients from controls, while higher F-M2PK could significantly identify colorectal cancer patients out of those had high FC levels.