Diagnostic Value of Fecal Calprotectin in Children with Gastritis, Duodenitis and Helicobacter Pylori

Mandana Rafeey, Pardis Nikmanesh, Farshad Javadzadeh


Background: Fecal calprotectin (FC) is suggested as a novel biomarker for the diagnosis of gastrointestinal (GI) diseases; however, few studies have investigated its diagnostic value for Helicobacter pylori (H. pylori). Therefore, the current study evaluated the level of FC and its diagnostic value in patients with H. Pylori and its related conditions including gastritis and duodenitis.

Methods: In this case‑control study, 120 children with upper GI symptoms, who were indicated to undergo upper GI endoscopic examination, were consecutively included. Patients were categorized into different groups based on their endoscopic findings including H. pylori, gastritis, duodenitis or normal.

Results: Patients with gastritis (P = 0.014) and those with duodenitis (P < 001) had significantly higher FC. The level of FC was higher in patients with H. pylori but this difference was marginally significant (P = 0.054). The level of FC had poor ability to diagnose the presence of H. pylori (P = 0.054) and gastritis (area under the curve, AUC = 0.639, P = 0.014). However, it had acceptable power to diagnose patients with or duodenitis (AUC = 0.718, P < 0.001). The sensitivity and specificity of FC for diagnosis of gastritis were 64 and 65 percent (cut‑off = 45.2 µg/g), and for duodenitis were 77 and 61 percent (cut‑off = 46.2 µg/g), respectively.

Conclusions: FC can be considered as an objective and diagnostic tool for duodenitis. However, due to the low sensitivity and specificity, it is suggested to consider it as an objective supplementary test beside other established diagnostic modalities.


Calprotectin; diagnosis; duodenitis; gastritis; Helicobacter pylori

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Zamani M, Ebrahimtabar F, Zamani V, Miller WH,

Alizadeh‑Navaei R, Shokri‑Shirvani J, et al. Systematic review

with meta‑analysis: The worldwide prevalence of Helicobacter

pylori infection. Aliment Pharmacol Ther 2018;47:868‑76.

Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE,

Tanyingoh D, et al. Global prevalence of Helicobacter pylori

infection: Systematic review and meta‑analysis. Gastroenterology


Moosazadeh M, Lankarani KB, Afshari M. Meta‑analysis of the

prevalence of Helicobacter pylori infection among children and

adults of Iran. Int J Prev Med 2016;7:48.

McColl KE. Clinical practice. Helicobacter pylori infection.

N Engl J Med 2010;362:1597‑604.

Rafeey M, Nikvash S. Detection of Helicobacter pylori antigen

in stool samples for diagnosis of infection in children. East

Mediterr Health J 2007;13:1067‑72.

Owen DR, Owen DA. Celiac disease and other causes of

duodenitis. Arch Pathol Lab Med 2018;142:35‑43.

Azer SA, Akhondi H. Gastritis. StatPearls [Internet]: StatPearls

Publishing; 2019.

Garza‑Gonzalez E, Perez‑Perez GI, Maldonado‑Garza HJ,

Bosques‑Padilla FJ. A review of Helicobacter pylori diagnosis,

treatment, and methods to detect eradication. World J

Gastroenterol 2014;20:1438‑49.

Kalach N, Bontems P, Raymond J. Helicobacter pylori infection

in children. Helicobacter 2017;22(Suppl 1):e12414.

McColl KE, Murray LS, Gillen D, Walker A, Wirz A,

Fletcher J, et al. Randomised trial of endoscopy with testing for

Helicobacter pylori compared with non‑invasive H pylori testing

alone in the management of dyspepsia. BMJ 2002;324:999‑1002.

Erbayrak M, Turkay C, Eraslan E, Cetinkaya H, Kasapoglu B,

Bektas M. The role of fecal calprotectin in investigating

inflammatory bowel diseases. Clinics (Sao Paulo) 2009;64:421‑5.

Korkmaz H, Kesli R, Karabagli P, Terzi Y. Comparison of the

diagnostic accuracy of five different stool antigen tests for

the diagnosis of Helicobacter pylori infection. Helicobacter


Khalilpour A, Kazemzadeh‑Narbat M, Tamayol A, Oklu R,

Khademhosseini A. Biomarkers and diagnostic tools for detection of

Helicobacter pylori. Appl Microbiol Biotechnol 2016;100:4723‑34.

Edelstein CL. Biomarkers in acute kidney injury. Biomarkers of

Kidney Disease. Elsevier; 2017. p. 241‑315.

Nakamura A, Kaneko N, Villemagne VL, Kato T, Doecke J,

Dore V, et al. High performance plasma amyloid‑beta biomarkers

for Alzheimer’s disease. Nature 2018;554:249‑54.

Wang J, Chen J, Sen S. MicroRNA as biomarkers and

diagnostics. J Cell Physiol 2016;231:25‑30.

Molaei A, Khomahani A, Sadeghi‑Shabestari M, Ghaffari S,

Sadat‑Ebrahimi S‑R. Cardiac biomarkers for early detection

of cardiac involvement in children with Kawasaki disease:

A cross‑sectional study. Int J Pediatr 2019;7:10573‑82.

Sadat‑Ebrahimi S‑R. Diagnostic and prognostic value of cardiac

biomarkers in children with Kawasaki disease: A state‑of‑the‑art

review. Int J Pediatr 2020;8:10911‑28.

Poullis A, Foster R, Shetty A, Fagerhol MK, Mendall MA.

Bowel inflammation as measured by fecal calprotectin: A link

between lifestyle factors and colorectal cancer risk. Cancer

Epidemiol Biomarkers Prev 2004;13:279‑84.

Shabestari MS, Rafeey M, Shoaran M, Shirvani S. Association

between fecal calprotectin concentration and mesenteric

lymphadenopathy in children. Crescent J Medical Biol Sci


Hanevik K, Hausken T, Morken MH, Strand EA, Morch K,

Coll P, et al. Persisting symptoms and duodenal inflammation

related to Giardia duodenalis infection. J Infect 2007;55:524‑30.

Berni Canani R, Rapacciuolo L, Romano MT,

Tanturri de Horatio L, Terrin G, Manguso F, et al. Diagnostic

value of faecal calprotectin in paediatric gastroenterology clinical

practice. Dig Liver Dis 2004;36:467‑70.

Poullis A, Foster R, Mendall MA, Fagerhol MK. Emerging

role of calprotectin in gastroenterology. J Gastroenterol Hepatol


Gisbert JP, McNicholl AG. Questions and answers on the role of

faecal calprotectin as a biological marker in inflammatory bowel

disease. Dig Liver Dis 2009;41:56‑66.

Montalto M, Gallo A, Ianiro G, Santoro L, D’Onofrio F, Ricci R,

et al. Can chronic gastritis cause an increase in fecal calprotectin

concentrations? World J Gastroenterol 2010;16:3406‑10.

Costa F, Mumolo MG, Bellini M, Romano MR, Ceccarelli L,

Arpe P, et al. Role of faecal calprotectin as non‑invasive marker

of intestinal inflammation. Dig Liver Dis 2003;35:642‑7.

Chu TH, Huang ST, Yang SF, Li CJ, Lin HW, Weng BC, et al.

Hepatoma‑derived growth factor participates in Helicobacter

Pylori‑induced neutrophils recruitment, gastritis and gastric

carcinogenesis. Oncogene 2019;38:6461‑77.

Whitmore LC, Weems MN, Allen LH. Cutting edge: Helicobacter

pylori induces nuclear hypersegmentation and subtype differentiation

of human neutrophils in vitro. J Immunol 2017;198:1793‑7.

Roseth AG, Fagerhol MK, Aadland E, Schjonsby H. Assessment

of the neutrophil dominating protein calprotectin in feces.

A methodologic study. Scand J Gastroenterol 1992;27:793‑8.

Tøn H, Brandsnes, Dale S, Holtlund J, Skuibina E,

Schjønsby H, et al. Improved assay for fecal calprotectin. Clin

Chim Acta 2000;292:41‑54.

Kyburz A, Muller A. Helicobacter pylori and extragastric

diseases. Curr Top Microbiol Immunol 2017;400:325‑47.

Manz M, Burri E, Rothen C, Tchanguizi N, Niederberger C,

Rossi L, et al. Value of fecal calprotectin in the evaluation of

patients with abdominal discomfort: An observational study.

BMC Gastroenterol 2012;12:5.

Ataee P, Afrasiabi V, Nikkhoo B, Sani MN, Rahehagh R,

Ghaderi E, et al. Relationship between fecal calprotectin and

upper endoscopy findings in children with upper gastrointestinal

symptoms. Iran J Pediatr 2017;27:e8658.

Wang S, Wang Z, Shi H, Heng L, Juan W, Yuan B, et al. Faecal

calprotectin concentrations in gastrointestinal diseases. J Int Med

Res 2013;41:1357‑61.

Hestvik E, Tumwine JK, Tylleskar T, Grahnquist L, Ndeezi G,

Kaddu‑Mulindwa DH, et al. Faecal calprotectin concentrations in

apparently healthy children aged 0‑12 years in urban Kampala,

Uganda: A community‑based survey. BMC Pediatr 2011;11:9.

Gaddy JA, Radin JN, Cullen TW, Chazin WJ, Skaar EP,

Trent MS, et al. Helicobacter pylori resists the antimicrobial

activity of calprotectin via lipid a modification and associated

biofilm formation. mBio 2015;6:e01349‑15.