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Association among different histologic scoring systems and accuracy of fecal calprotectin for clinical and histologic remission
Published online: April 30, 2025


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Full Article

Predictive accuracy of fecal calprotectin for histologic remission in ulcerative colitis
Intest Res. 2025;23(2):144-156

Histologic remission is increasingly recognized as an important objective in the management of ulcerative colitis (UC). However, histologic evaluation requires invasive procedures, prompting interest in fecal calprotectin (FC) as a non-invasive surrogate marker.
In this prospective observational cohort study (n = 347), patients with UC underwent concurrent clinical, endoscopic, biochemical, and histologic evaluations. Four histologic indices (Geboes Score (GS), Continuous GS, Nancy Index (NI), and Robarts Histopathology Index (RHI)) were evaluated for internal concordance and their correlation with FC concentrations. The concordance between different histologic indices was high. FC levels demonstrated fair correlations with clinical, endoscopic, and histologic parameters. Notably, an FC threshold below 100 μg/g predicted histologic remission with greater than 80% accuracy, irrespective of the histologic scoring system applied. These results underscore the potential of FC as a reliable, non-invasive biomarker indicative of histologic remission.

  1. There was a moderate to strong correlation among histologic indices (Geboes Score, Continuous Geboes Score, Nancy Index, Robarts Histopathology Index) and poor to fair correlation between clinical or endoscopic indices (partial Mayo score, Mayo endoscopic score, total Mayo score) and histologic indices.
  2. The concordance between different histologic indices was high.
  3. The FC values had fair correlations with clinical, endoscopic, and histologic scores.
  4. A cutoff for FC (less than 100 μg/g) had >80% accuracy in identifying patients who were in histologic remission, regardless of the histologic indices used.

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