Review for 10.1186/s12876-025-04200-7 (2025)

Title: The value of fecal calprotectin measured by fluorescent immunochromatography assay
in evaluating clinical and endoscopic activity in ulcerative colitis
Version: 0 Date: 14 May 2025
Reviewer's report:
Dear Editor,
Dear Reviewer,
I appreciate the opportunity to review the Article titled “The value of faecal calprotectin
measured by fluorescent immunochromatography assay in evaluating clinical and endoscopic
activity in ulcerative colitis”, which was submitted to BMC Gastroenterology.
The article establishes the utility of faecal calprotectin and its cut-offs for disease monitoring
in the context of ulcerative colitis.
In general, the article is well written and there is a clear design. While the topic is of clinical
interest, I have several issues - both methodological and interpretative – that should be addressed
to improve the manuscript.
• In the methods, the authors state that patients were hospitalized, but the baseline characteristics
do not reflect a population with acute severe colitis or typical hospitalization criteria. Please
clarify
• The introduction refers to UC as being characterized by mucosal ulceration. While this is often
true in severe cases, many patients with active disease—particularly mild to moderate—do not
have visible ulcers. Please revise.
• The introduction suggests that CRP and ESR are widely used to monitor flares, but
these biomarkers are known to be suboptimal for routine disease monitoring and are mainly
recommended in the context of acute severe UC (ASUC). This should be more accurately
framed. The finding that FC correlates better with CRP and ESR is expected, based on prior
literature.
• The authors mention that fewer reports exist on FC cut-offs using immunochromatography,
but they do not cite relevant literature or describe the specific cut-offs observed in these studies.
Could they clarify, this may impact the rationale and context of the study.
• In general the results section should be expanded, the authors refer to the relevant tables but
statistical output is missing in the written text (e.g. p-value, …). The findings require more depth
and transparency.
• The conclusion that FC levels correlated best with E1 disease is counterintuitive and
inconsistent with existing literature, which generally shows higher FC values with more
extensive inflammation (E2–E3). Could the authors clarify and explain their findings in more
detail, were potential confounders explored?
• The study could be further strengthened by including histological data to support the
endoscopic and biomarker findings, if available.
• Several references are missing or contain placeholders such as “Error! Reference source not
found.” These must be corrected.
• The discussion recommends collecting normally formed stools from the first bowel movement,
which is unrealistic in patients with active UC who typically pass loose or liquid stools. This
statement should be revised for clinical appropriateness.
• The patient characteristics suggest inclusion of a patient with a proctocolectomy. It is unclear
how this patient was evaluated using the partial Mayo score (pMS) or Mayo endoscopic score
(MES). Please revise this data.