Review for 10.1186/s12876-018-0853-4 (2018)

Reviewer ’s report  
 
Title: Faecal Calprotectin Level for Assessing Endoscopic Activity and Predicting Future Clinical  
Course in Patients with Moderately Active Ulcerative Colitis Undergoing 
Granulomonocytap heresis:  A Prospective Cohort Study  
 
Version: 0 Date: 21 May 2018  
 
Reviewer: Renata D'Inca  
 
Reviewer's report:  
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Literature about the reliability of fecal calprotectin is rapidly expanding in several settings of IBD 
field.  
GMA is a therapeutic option for the treatment of UC  patients, largely employed in Japan, less in 
Western countries where it is generally considered best suitable for mild to moderate disease 
activity.  
Literature about fecal calprotectin and GMA is lacking.  
The present study is well designed and conducted, especially because endoscopy was undertaken 
in all patients.  
All patients had active disease at entry with a Mayo endoscopic subscore ≥2 (Mayo 0 -1 was 
considered as Mucosal Healing) and the median FC level at entry was 140 (52 -317) ug/g. This is 
a quite lo w value for at least endoscopically moderate disease and often reported in the FC 
literature as a level that could identify remission of the disease.  
Patients who achieved clinical remission and mucosal healing had even lower levels (99 and 59.5 
ug/g) at s tudy entry. These values are incredibly low and generally used to discriminate healthy 
people from patients with GI symptoms, not often found in patients with known IBD in their active 
phase.  
Although there was a significant decrease in FC levels after GMA  treatment, patients responding 
(remission and mucosal healing) were those with even lower levels of FC, therefore with milder 
disease. This behavior is different from the treatment with biologics, in which a fast and sharp 
decrease in FC levels has been d emonstrated after induction regimens.  
Furthermore, PPV and NPV are not that satisfying.  
In conclusion, the present work is clinically relevant and well conducted.  
However, results are not generalizable and somewhat in contrast with the knowledge acquired 
about FC and for sure need to be further validated.  
 
Are the methods appropriate and well described?  
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Yes 
Does the work include the necessary controls?  
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Yes 
Are the conclusions drawn adequately supported by the data shown?  
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Yes 
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I am able to assess the statistics  
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Not suitable for publication unless extensively edited  
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