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

Reviewer ’s report  
 
Title: Faecal Calprotectin Level f or Assessing Endoscopic Activity and Predicting Future Clinical  
Course in Patients with Moderately Active Ulcerative Colitis Undergoing 
Granulomonocytapheresis:  A Prospective Cohort Study  
 
Version: 1 Date: 25 Jun 2018  
 
Reviewer: Renata D'Inca  
 
Reviewer's repo rt: 
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attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be  included in a text format.  
Please oLiterature 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 coun tries 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 patient s. 
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 low value for at least endoscopically moderate disease and o ften 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 study 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 hea ling) 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 demonstrated 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.  
 
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Are the methods appropriate and well described?  
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Yes 
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Yes 
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No 
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I am able to assess the statistics  
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Acceptable  
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