Serial fecal calprotectin as a screening tool for subclinical ileitis in patients with idiopathic uveitis or scleritis: a prospective cohort study
8 affiliations
- 1Department of Medicine, Faculty of Medicine, Complutense University of Madrid (UCM), Madrid, Spain
- 2Department of Internal Medicine, Gregorio Marañón University General Hospital (HGUGM), Madrid, Spain
- 3Centre for Immune-Mediated Diseases (CEIMI), Gregorio Marañón University General Hospital (HGUGM), Madrid, Spain
- 4Instituto de Investigacion Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- 5Department of Gastroenterology, Gregorio Marañón University General Hospital (HGUGM), Madrid, Spain
- 6Department of Geriatric, Gregorio Marañón University General Hospital (HGUGM), Madrid, Spain
- 7Department of Ophthalmology, Gregorio Marañón University General Hospital (HGUGM), Madrid, Spain
- 8Department of Clinical Biochemistry, Gregorio Marañón University General Hospital (HGUGM), Madrid, Spain
Abstract
Idiopathic uveitis accounts for 27%–51% of uveitis cases in Europe and the United States. Subclinical inflammatory bowel disease (IBD) may remain undiagnosed in patients with idiopathic uveitis or scleritis despite shared immunopathogenic mechanisms and the absence of digestive symptoms. Early identification may enable intervention within the inflammatory window of opportunity, yet subclinical ileitis has not been systematically explored in this population. We evaluated the diagnostic performance of serial fecal calprotectin for identifying subclinical inflammatory bowel disease in a prospective cohort of 69 patients with idiopathic uveitis or scleritis, using a baseline measurement repeated at 6–12 months if negative or at three months if positive, defining four longitudinal patterns (A–D). Subclinical ileitis was confirmed by capsule endoscopy and/or colonoscopy in 5 of the 62 patients with an evaluable outcome (8.1%). Baseline fecal calprotectin was significantly higher in patients with confirmed ileitis (p = 0.024), a difference that became more pronounced at the second determination (p = 0.002). The pattern of persistent elevation (subgroup D) showed the best diagnostic balance: sensitivity 100% (exact 95% CI: 47.8–100.0), specificity 82.5% (95% CI: 70.1–91.3), negative predictive value 100% (95% CI: 92.5–100.0), and positive likelihood ratio 5.7 (95% CI: 3.25–10.01). ROC curve analysis showed a numerically higher discriminative capacity for the second calprotectin determination (AUC: 0.932; 95% CI: 0.850–1.000) than for the baseline measurement (AUC: 0.809; 95% CI: 0.652–0.966), although a formal DeLong comparison between both c-statistics found no statistically significant difference (p = 0.242). This exploratory, hypothesis-generating cohort suggests that a persistently elevated fecal calprotectin trajectory identifies a subgroup of patients with idiopathic uveitis or scleritis who may warrant digestive evaluation; because subgroups A and C were not endoscopically verified, the reported sensitivity and negative predictive value are estimates conditioned on this verification scheme and on only five events, not validated evidence that a negative trajectory excludes subclinical ileitis. Confirmation in larger, prospectively verified, multicenter cohorts is required before any screening recommendation can be made.
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BibTeX
@article{olleros2026serial,
title = {{Serial fecal calprotectin as a screening tool for subclinical ileitis in patients with idiopathic uveitis or scleritis: a prospective cohort study}},
author = {Cristina Lavilla Olleros and Cristina Lavilla Olleros and Cristina Lavilla Olleros and Cristina Lavilla Olleros and Luis Menchén and Luis Menchén and Luis Menchén and Luis Menchén and Joana Ramos-Ferreira and Beatriz Merino Rodríguez and José María de Miguel-Yanes and José María de Miguel-Yanes and Rosa Gutierrez Bonet and Rosa Gutierrez Bonet and Javier Torresano Rodríguez and Javier Torresano Rodríguez and Javier Torresano Rodríguez and Cristina Ausín García and Cristina Ausín García and Carolina Puertas López and Luis Alvarez-Sala Walther and Luis Alvarez-Sala Walther and Luis Alvarez-Sala Walther and Lucía Ibares-Frías and Lucía Ibares-Frías and Lucía Ibares-Frías and Lucía Ibares-Frías},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1968285},
url = {https://doi.org/10.3389/fmed.2026.1968285},
note = {CC BY},
}
RIS
TY - JOUR
TI - Serial fecal calprotectin as a screening tool for subclinical ileitis in patients with idiopathic uveitis or scleritis: a prospective cohort study
AU - Cristina Lavilla Olleros
AU - Cristina Lavilla Olleros
AU - Cristina Lavilla Olleros
AU - Cristina Lavilla Olleros
AU - Luis Menchén
AU - Luis Menchén
AU - Luis Menchén
AU - Luis Menchén
AU - Joana Ramos-Ferreira
AU - Beatriz Merino Rodríguez
AU - José María de Miguel-Yanes
AU - José María de Miguel-Yanes
AU - Rosa Gutierrez Bonet
AU - Rosa Gutierrez Bonet
AU - Javier Torresano Rodríguez
AU - Javier Torresano Rodríguez
AU - Javier Torresano Rodríguez
AU - Cristina Ausín García
AU - Cristina Ausín García
AU - Carolina Puertas López
AU - Luis Alvarez-Sala Walther
AU - Luis Alvarez-Sala Walther
AU - Luis Alvarez-Sala Walther
AU - Lucía Ibares-Frías
AU - Lucía Ibares-Frías
AU - Lucía Ibares-Frías
AU - Lucía Ibares-Frías
PY - 2026
DA - 2026/10/26
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1968285
UR - https://doi.org/10.3389/fmed.2026.1968285
AB - Idiopathic uveitis accounts for 27%–51% of uveitis cases in Europe and the United States. Subclinical inflammatory bowel disease (IBD) may remain undiagnosed in patients with idiopathic uveitis or scleritis despite shared immunopathogenic mechanisms and the absence of digestive symptoms. Early identification may enable intervention within the inflammatory window of opportunity, yet subclinical ileitis has not been systematically explored in this population. We evaluated the diagnostic performance of serial fecal calprotectin for identifying subclinical inflammatory bowel disease in a prospective cohort of 69 patients with idiopathic uveitis or scleritis, using a baseline measurement repeated at 6–12 months if negative or at three months if positive, defining four longitudinal patterns (A–D). Subclinical ileitis was confirmed by capsule endoscopy and/or colonoscopy in 5 of the 62 patients with an evaluable outcome (8.1%). Baseline fecal calprotectin was significantly higher in patients with confirmed ileitis (p = 0.024), a difference that became more pronounced at the second determination (p = 0.002). The pattern of persistent elevation (subgroup D) showed the best diagnostic balance: sensitivity 100% (exact 95% CI: 47.8–100.0), specificity 82.5% (95% CI: 70.1–91.3), negative predictive value 100% (95% CI: 92.5–100.0), and positive likelihood ratio 5.7 (95% CI: 3.25–10.01). ROC curve analysis showed a numerically higher discriminative capacity for the second calprotectin determination (AUC: 0.932; 95% CI: 0.850–1.000) than for the baseline measurement (AUC: 0.809; 95% CI: 0.652–0.966), although a formal DeLong comparison between both c-statistics found no statistically significant difference (p = 0.242). This exploratory, hypothesis-generating cohort suggests that a persistently elevated fecal calprotectin trajectory identifies a subgroup of patients with idiopathic uveitis or scleritis who may warrant digestive evaluation; because subgroups A and C were not endoscopically verified, the reported sensitivity and negative predictive value are estimates conditioned on this verification scheme and on only five events, not validated evidence that a negative trajectory excludes subclinical ileitis. Confirmation in larger, prospectively verified, multicenter cohorts is required before any screening recommendation can be made.
SN - 2296-858X
ER -