Introduction Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent fever and serositis. Gastrointestinal involvement and subclinical intestinal inflammation have been reported in FMF, with elevated fecal calprotectin (FC) levels even during attack-free periods. This study aimed to investigate the relationship between colonoscopic findings and FC levels in pediatric FMF patients presenting with gastrointestinal symptoms. Methods This retrospective cohort study included children under 18 years of age with FMF who underwent colonoscopy for gastrointestinal symptoms between 2018 and 2024. Patients were categorized into three groups based on colonoscopic findings: normal colonoscopy, nonspecific findings, and inflammatory bowel disease (IBD). Demographic data, laboratory results, and FC levels were analyzed. ROC analysis was performed to identify the FC cutoff value predictive of colitis. Results A total of 81 patients (median age 12 years; 51.9% male) were included. FC levels were significantly higher in the IBD group compared to other groups (p < 0.001). Albumin levels were lower in IBD patients (p = 0.013). ROC analysis revealed that an FC level below 123 µg/g predicted normal colonoscopic findings with 89.8% sensitivity and 84.4% specificity (AUC 0.902). Conclusion FC may serve as a useful non-invasive biomarker for predicting colonoscopic abnormalities in pediatric FMF patients. An FC level below 123 µg/g appears to reliably predict normal colonoscopic findings, suggesting that unnecessary invasive procedures may be avoided in this subgroup. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • Fecal calprotectin levels correlated with the severity of colonoscopic abnormalities in FMF patients with gastrointestinal symptoms. • A fecal calprotectin level below 123 µg/g feces strongly predicted normal colonoscopic findings. • Fecal calprotectin may serve as a useful non-invasive tool to reduce unnecessary colonoscopic procedures in pediatric FMF patients. </entry> </row> </tbody> </tgroup> </Table>

Association between colonoscopic findings and fecal calprotectin levels in familial Mediterranean fever patients with gastrointestinal symptoms: a retrospective cohort study

期刊论文
发表日期：

2026年6月18日

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Büşra Tetik Dinçer,
Nafiye Urgancı,
Mustafa Çavuşoğlu,
Gül Özçelik,
Merve Usta

摘要

Introduction

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent fever and serositis. Gastrointestinal involvement and subclinical intestinal inflammation have been reported in FMF, with elevated fecal calprotectin (FC) levels even during attack-free periods. This study aimed to investigate the relationship between colonoscopic findings and FC levels in pediatric FMF patients presenting with gastrointestinal symptoms.

Methods

This retrospective cohort study included children under 18 years of age with FMF who underwent colonoscopy for gastrointestinal symptoms between 2018 and 2024. Patients were categorized into three groups based on colonoscopic findings: normal colonoscopy, nonspecific findings, and inflammatory bowel disease (IBD). Demographic data, laboratory results, and FC levels were analyzed. ROC analysis was performed to identify the FC cutoff value predictive of colitis.

Results

A total of 81 patients (median age 12 years; 51.9% male) were included. FC levels were significantly higher in the IBD group compared to other groups (p < 0.001). Albumin levels were lower in IBD patients (p = 0.013). ROC analysis revealed that an FC level below 123 µg/g predicted normal colonoscopic findings with 89.8% sensitivity and 84.4% specificity (AUC 0.902).

Conclusion

FC may serve as a useful non-invasive biomarker for predicting colonoscopic abnormalities in pediatric FMF patients. An FC level below 123 µg/g appears to reliably predict normal colonoscopic findings, suggesting that unnecessary invasive procedures may be avoided in this subgroup.

Key Points

• Fecal calprotectin levels correlated with the severity of colonoscopic abnormalities in FMF patients with gastrointestinal symptoms.

• A fecal calprotectin level below 123 µg/g feces strongly predicted normal colonoscopic findings.

• Fecal calprotectin may serve as a useful non-invasive tool to reduce unnecessary colonoscopic procedures in pediatric FMF patients.