







































_____________________________________________________________________________________________________ 
 
*Corresponding author: E-mail: nassarasma20@gmail.com; 
 
Cite as: Nassar, Asma, Amina Alliouch -kerboua, Hacene Meriche, Nassima Sabiha Gadiri, and Frida Chettab. 2025. “Clinical 
Profile and Analysis of Biological Markers (Fecal Calprotectin and CRP) During Relapse of Inflammatory Bowel Diseases in a 
Population of Adults”. Asian Journal of Immunology 8 (1):104-19. https://doi.org/10.9734/aji/2025/v8i1165. 
 

 
 

Asian Journal of Immunology 
 
Volume 8, Issue 1, Page 104-119, 2025; Article no.AJI.135189 
 

 
 

 

 

Clinical Profile and Analysis of 
Biological Markers (Fecal Calprotectin 

and CRP) during Relapse of 
Inflammatory Bowel Diseases in a 

Population of Adults 
 

Asma Nassar a*, Amina Alliouch -kerboua a,  
Hacene Meriche a, Nassima Sabiha Gadiri a  

and Frida Chettab b 
 

a Department of Immunology, Clinique Saint Therese UHC, Annaba, Algeria. 
b Department of Gastroentero-Hepatology, Hospital Ibn Sina UHC, Annaba, Algeria. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. All authors read and approved the final 

manuscript. 
 

Article Information 
 

DOI: https://doi.org/10.9734/aji/2025/v8i1165  
 

Open Peer Review History: 
This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,  

peer review comments, different versions of the manuscript, comments of the editors, etc are available here: 
https://pr.sdiarticle5.com/review-history/135189  

 

 
Received: 26/02/2025 

Published: 05/05/2025 

 
 

ABSTRACT 
 

Inflammatory bowel diseases (IBD) are increasingly common pathologies, affecting both adults and 
children. This study investigates the clinical and epidemiological characteristics of IBD among 
patients at the gastroentero-hepatology department of Annaba University Hospital. Conducted from 

Original Research Article 

https://doi.org/10.9734/aji/2025/v8i1165
https://pr.sdiarticle5.com/review-history/135189


 
 
 
 

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105 

 

February 2023 to September 2024, the prospective descriptive analytical study included 77 patients 
diagnosed with IBD, focusing on the role of biological markers, specifically C-reactive protein (CRP) 
and fecal calprotectin (FC), in non-invasive disease assessment. 
Inclusion criteria were based on clinical, endoscopic and histological assessments. Demographic 
data, clinical manifestations, CRP and FC levels were analyzed. 
Among the 77 patients, 53 patients or 68.9% had Crohn's disease (CD), while 24 patients or 31.1% 
suffered from ulcerative colitis (UC). The most prevalent symptoms were abdominal pain and 
chronic diarrhea. Among CD patients, ileal involvement was common in 21 cases (39.62%) with  25 
cases (32,47 %)  experiencing complications 
The study found that 34 or 46.57% of patients had elevated CRP levels, with a higher prevalence in 
those with CD compared to UC. A statistically significant association was observed between CRP 
levels and IBD type. 
Additionally, the analysis revealed that among patients experiencing relapse, 20 cases or 52.63% 
had positive FC results, compared to 14 cases or  35.9% in remission, indicating a significant 
correlation between relapse status and FC levels (P=0.018). However, no significant association 
was found between relapse status and CRP levels, although a significant difference in mean CRP 
levels between active and remission states in UC was noted (P=0.03). A weak positive correlation (r 
=0.12) between CRP and FC during active phases was also identified. 
The findings underscore the clinical and epidemiological profile of IBD in this population, 
highlighting the importance of FC as a valuable marker for monitoring disease activity and relapse 
status in IBD patients. 
 

 
Keywords: Fecal calprotectin; inflammatory bowel disease; crohn's disease; ulcerative colitis; C-

reactive protein. 
 

1. INTRODUCTION  
 

Chronic inflammatory bowel diseases (IBD), 
including Crohn's disease (CD) and ulcerative 
colitis (UC), are chronic and progressive 
pathologies responsible for irreversible 
destruction of the digestive tract, leading to 
significant alteration in quality of life. Diagnosis of 
IBD is often difficult in clinical practice, due to 
pathognomonic symptoms and considerable 
overlap with those of irritable bowel syndrome 
(Ulcerative colitis - PubMed, 2024; Torres et al., 
2017) 
 

Although endoscopy has been the mainstay of 
IBD assessment, the feasibility of using ileo 
colonoscopy repeatedly for long-term follow-up is 
limited by its availability, invasiveness, patient 
tolerance and cost. There is therefore 
considerable interest in using non-invasive 
biomarkers to monitor IBD activity (Ma et al., 
2019).  
 

FC, a neutrophil-derived protein, is the most 
sensitive biomarker of intestinal inflammation. FC 
levels correlate well with endoscopic scores in 
CD and UC. Today, FC is used in a variety of 
clinical settings, notably for the initial diagnosis of 
IBD (D’Amico et al., 2021).Although FC and CRP 
are the most studied biomarkers in this field, 
there are concerns about the sensitivity and 
specificity of CRP in IBD patients. Moreover, 

patients often prefer blood tests to stool 
collection, which limits the acceptability of FC. 
Finally, the optimal thresholds for FC to predict 
disease activity vary according to IBD phenotype 
and the tests used (Swaminathan & Day, 2024). 
 

Our study aims to assess the clinical and 
epidemiological profile of IBD in adult population. 
It also explores the correlation between CRP 
levels and FC in the context of IBD, to better 
understand their usefulness as biological 
markers in monitoring intestinal inflammation. 
 

2. MATERIALS AND METHODS  
 

The present study was conducted in the 
Immunology Laboratory at Annaba University 
Hospital, Annaba/Algeria, over a period of 19 
months, from February 9, 2023, to September 
30, 2024. This is a prospective descriptive-
analytical study involving a sample of 77 adult 
patients referred by the gastroenterology and 
hepatology department at Annaba University 
Hospital. The sample consisted of 29 males and 
48 females, with an average age of 39.7 ± 17.47 
years, a median age of 34 years, and a mode of 
34 years. The age range was from 17 to 82 
years, resulting in a male-to-female ratio of 0.6. 
 

Inclusion Criteria 
 

Patients included in our study represent those 
whose diagnosis of IBD (UC/CD) was confirmed 



 
 
 
 

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106 

 

on the basis of clinical, endoscopic, and 
histological criteria (Montreal Classifications) and 
referred to the immunology laboratory for 
immunological work-up: Determination of FC and 
CRP. 
 
Exclusion Criteria 
 
Patients whose diagnosis of IBD has not been 
confirmed (still under investigation). 
Patients with incomplete or unusable clinical 
records. 
Patients diagnosed with indeterminate colitis. 
77 patients met the criteria and consented to 
participate in the study 
 

2.1 The Included Immunological Analysis 
Techniques 

 
Included among the immunological analysis 
techniques were: 
 
– Determination of the FC using the sandwich 
ELISA technique (enzyme-linked immunosorbent 
assay from INOVA DIAGNOSTICS) on stool 
samples 
 
– Determination of CRP by FAI (fluorescence 
Immunoassay) on a serum samples. 
 

2.2 Data Collection and Statistical 
Analysis 

 
Statistical analyses were conducted using SPSS 
software. The following statistical tests were 
employed to compare the different subgroups: 
 
✓ Chi-square test: Used for comparing 

qualitative variables. 
✓ Student's t-test and Analysis of Variance 

(ANOVA): Utilized for comparing means 
across groups. 

✓ Spearman's rank correlation: Applied to 
assess the correlation between FC levels 
and CRP levels. 

 
A significance level of 0.05 was established for 
all analyses. 
 

3. RESULTS 
 

3.1 Study Population Description 
 
The study population consisted of 77 patients 
referred by the gastroenterology department. 
Among the included patients, 53 (68.9%) were 

diagnosed with Crohn's disease (CD) and 24 
(31.1%) with ulcerative colitis (UC). Specifically, 
CD was identified in 20 men (25.97% of cases) 
and 33 women (42.85% of cases), resulting in a 
male-to-female ratio of 0.6. UC was diagnosed in 
15 women (19.48% of patients) and 11 men 
(11.68% of patients), yielding a male-to-female 
ratio of 0.73. No significant association was 
found between gender and type of IBD (UC or 
CD). 
 
In our cohort of CD cases, ileal localization was 
the most prevalent, accounting for 21 cases 
(39.62%), followed by colonic localization, which 
involved 14 patients (23.81%). Additionally, 5 
patients (5.3% of the cohort) were active 
smokers. 
 
Regarding disease activity, 38 patients (49.35%) 
were in the relapse phase, including 24 with CD; 
however, no statistically significant association 
was observed. 
 
In terms of treatment, 15 (19, 5 %) of patients 
received anti-TNF therapy, 12 (15, 6 %) were on 
a combination of therapies, 11 (14.3%) were 
treated with corticosteroids, while 8 (10.4%) 
received immunosuppressants and 6 (7.8%) 
were treated with salicylates. (Table 1) 
 
Complications of IBD: The results suggest that 
the obstructive tableau is more frequent in 
patients with CD, with a statistically significant 
difference (P = 0.04). 
 
There is a trend towards a difference for fistulas, 
although not significant (P = 0.07). 
 
Other complications (stenosis, abdominal mass) 
show no significant differences between CD and 
UC patients (Fig. 1). 
 
Digestive manifestations : Digestive 
manifestations were dominated by abdominal 
pain in 55 cases (71.43%), followed by chronic 
diarrhea in 50 cases (64.93%), rectal bleeding in 
15 cases or 19.48 % (14.28 of cases with UC), 
purulent diarrhea and false needs in 7 cases 
(9.09%) and constipation in 3 cases (3.9%). 
Rectal bleeding is significantly more frequent in 
UC patients (P< 0.0001), consistent with this 
disease. 
 
Other symptoms (abdominal pain, chronic 
diarrhea, false needs, purulent diarrhea, and 
constipation) showed no significant differences 
between CD and UC patients. (Table 2) 



 
 
 
 

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Extra-digestive manifestations: None of the 
extra-intestinal manifestations evaluated 
(peripheral arthritis, axial rheumatism, uveitis, 

erythema nodosum, oral ulcerations, steatosis) 
showed any statistically significant difference 
between UC and CD patients. (Table 3) 

 

Table 1. Description of study population 
 

 Sample 
size 

Percentage Pearson Chi-
square test 

Type of IBD 
CD 
UC 

 
53 
24 

 
68,9% 
31,1% 

 

IBD by Gender 
CD 
Man 
Woman 
UC 
Man 
Woman 

 
 
20 
33 
 
9 
15 

 
 
25,97% 
42,85% 
 
11,68% 
19,48% 

 
 
 
P=0,98 
 
 
 

Localization (CD) 
Ileal 
Ileocolic 
colonic 

 
21 
13 
14 

 
39,62 % 
24,52 % 
26,41 % 

 

Smoking Factor 
Smoker 

 
5 

 
5,3% 

 

IBD in Relapse Phase 
CD 
UC 

 
24 
14 

 
31,17% 
18,18% 

 
P=0,28 

Treatments 
Corticosteroids 
 Immunosuppressants 
Anti-TNF 
Aminosalicylates (5-ASA)  
Combination Therapy 

 
11 
8 
15 
6 
12 

 
14,3 % 
10,4 % 
19,5 %  
7,8 % 
15,6 % 

 

 

 

Fig. 1. IBD population distribution based on complications 
 

Table 2. IBD cases distribution based on digestive symptoms 
 

 Abdominal 
pain 

Chronic 
diarrhea 

Rectal 
bleeding 

False 
needs 

purulent 
diarrhea 

Constipation 

CD 40 (51, 9%) 35(45, 45%) 4(5, 19%) 6(7,79%) 5(6,49%) 1(1,3%) 
UC 15(19,5%) 15(19,5%) 11(14,28%) 1(1,3%) 2(2,6%) 2(2,6%) 
Total 55 50 15 7 7 3 
% 71,43 64,93 19,48 9,09 9,09 3,9 
P 0,24 0,76 <0,0001 0,30 0,87 0,17 

0 5 10 15

stenosis

fistula

abdominal mass

obstructive tableau

UC CD

P=0.04 



 
 
 
 

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Table 3. Population distribution based on extra-digestive symptoms 
 

 Peripheral 
arthritis 

Axial 
rheumatism 

Uveitis Erythema 
nodosum 

Oral 
ulcerations 

Steatosis 

UC 3(3,9%) 2(2,6%) 2(2,6%) 0 4(5,2%) 0 
CD 20(25,97%) 7(9,09%) 6(7,8%) 3(3,9%) 12(15,6%) 3(3,9%) 
Total 23 9 8 3 16 3 
% 29,87 11,69 10,39 3,9 20,78 3,9 
p 0,25 0,53 0,69 0,23 0,54 0,23 

 

3.2 FC and CRP Assay Results 
 
3.2.1 Population distribution based on FC 

findings 
 
Among the 77 patients, 34 (44.2%) were FC 
positive, 36 (46.8%) were FC negative and 7 
(9.1%) were FC equivocal (Table 4). 
 
3.2.2 FC results in relapse/non-relapse status 
 
The results show a significant difference between 
relapsing and non-relapsing patients in terms of 
FC. 
 
Patients in relapse had a higher proportion of 
positive FC (20 patients or 52.63%) compared 
with patients not in relapse (14 patients or 

35.9%), and none of the patients in relapse had 
an equivocal FC. 
 
This difference is confirmed by a P-value of 
0.018, indicating a significant association 
between relapse status and FC. (Table 5) 
 
3.2.3 FC results according to IBD 
 
The results indicate that, although there are 
differences in FC between the relapse and 
remission phases, these differences are not 
statistically significant, with a P-value of 0.10 for 
both CD and UC patients. (Table 6) 
 
The comparison between UC and CD during the 
relapse phases yielded a P-value of 0.27, also 
non-significant. (Table 7). 

 
Table 4. Population distribution based on FC findings 

 

 Positive 
FC 

Negative FC Equivocal  FC Total 

Number of patients 34 36 7 77 
% 44,2 46,8 9,1 100 

 
Table 5. FC results in relapse/non-relapse status 

 

 Positive FC Negative FC Equivocal FC 

Relapse 20(52,63%) 18(47,37%) 0 
Non- relapse 14(35,9%) 18(46,15%) 7(17,9%) 
Total 34(44, 2%) 36(46, 8%) 7(9, 1%) 
Pearson Chi-square test P= 0,018 

 
Table 6. FC results according to the type of IBD and active/inactive Status 

 

 Positive FC  Negative FC Equivocal FC Pearson Chi-square test 

CD (Relapse) 
24 cases 

11(45,83%) 13(54,17%) 0 P=0,10 

CD (non -Relapse) 
29cases  

11(37,93%) 13(44,83%) 5(17,24%) 

UC(Relapse) 
14 cases 

9(64,29%) 5(35,71%) 0 P=0,10 

UC (non -Relapse) 
10 cases  

3(30%) 5(50%) 2(20%) 

Total (77) 34(44,2%) 36(46,8%) 7(9,1%)  



 
 
 
 

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Table 7. Comparison of FC results between UC and CD during relapse phase 
 

 Positive FC Negative FC Equivocal FC Pearson Chi-square test 

CD (relapse) 
24 cases 

11(45,83%) 13(45,17%) 0  
P=0,27 

UC (relapse) 
14 cases 

9(64,29%) 5(35,71%) 0 

Total (38) 20(52,63%) 18(47,37%) 0  

 
3.2.4 Distribution of the population according 

to CRP Levels 
 
In our study, 34 patients (46.57%) had a CRP 
level of ≥ 6 mg/L, while 39 patients (53.42%) had 
a CRP level of < 6 mg/L. Patients with CD had a 
higher proportion of positive CRP compared to 
patients with UC. The Fisher's exact test showed 
a statistically significant association (P=0.007) 
between CRP levels and the type of IBD (Fig. 2). 
 
3.2.5 CRP Results according to 

active/inactive disease status 
 
The results suggest that there is no significant 
link between disease status (active or inactive) 

and CRP levels (<6 and ≥6), according to 
Fisher's exact test (P = 0.48). (Table 8) 
 
3.2.6 CRP Results According to the Type of 

IBD 
 
In patients with CD, no significant difference in 
CRP levels was observed between the active 
and remission phases (P = 0.80). For UC, there 
is a trend toward a difference, but it is not 
statistically significant (P = 0.08). (Table 9) 
 
The comparison between patients with active CD 
and those with active ulcerative colitis UC also 
yields a non-significant result (P = 0.17).                   
(Table 10). 

 

 
 

Fig. 2. Distribution of the Population According to CRP Levels 
 

Table 8. CRP Results According to Active/Inactive Disease Status 
 

 CRP <6 mg/l CRP≥ 6mg/l Fisher's exact test 

relapse 37 cases 18 (48,65%) 19 (51,35%)  
P=0,48 Non –relapse 36 cases 21 (58,33%) 15 (41,67%) 

Total (73) 39 (53,42%) 34 (46,57%) 

 
Table 9. CRP Results According to the Type of IBD 

 

 CRP <6mg/l CRP≥6mg/l Pearson  Chi-square test 

CD (relapse) 24 cases 14(58,33%) 10(41,67%)  
P= 0,80 CD (non-relapse) 29 cases 16(55,17 %) 13(44,83%) 

UC  (relapse) 13 cases 4(30,77%) 9(69,23%)  
P=0,08 UC (on-relapse) 7 cases 5(71,42%) 2(28,6%) 

Total (73) 39 (53,42%) 34(46,57%) 

0

10

20

30

CD UC

<6 30 9

6≥ 23 11

30

9

23

11

<6 6≥

P=0,007 



 
 
 
 

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Table 10. Comparison of CRP Results between CD and UC in Active Phase 
 

 CRP <6mg/l CRP≥6mg/l Pearson  Chi-square test 

CD (relapse) 24 cases 14(58,33%) 10(41,67%)  
 
P= 0,17 

UC (relapse) 13 cases 4(30,77%) 9(69,23%) 

Total (37) 18(48,65%) 19(51,35%) 

 
3.2.7 CRP /FC Results According to Different 

Locations in Crohn's Disease 
 
There is no statistically significant difference 
between FC results and the different localization 
in CD (Table 11). 
 
The results indicate that there is no statistically 
significant difference in CRP levels (≥ 6 or < 6) 
for ileal and ileocolonic locations. However, there 
is a suggestive trend in the colonic location with 
a P-value of 0.06 (Table 12). 
 

3.3  Comparison of the Average Rate of 
FC and CRP 

 
3.3.1 Comparison of the average rate of FC 

between CD and UC during flare-up 
 
The average rate of FC is higher during UC than 
in CD, however these results do not establish a 

significant distinction between UC and CD in 
terms of FC (P=0.09). (Table 13) 
 
3.3.2 Comparison of the Mean FC levels 

between active and remission states in 
UC 

 
The mean FC levels are higher in patients in the 
'active' state (531 mg/L) compared to those in 
'remission' (412.6 mg/L). However, the standard 
deviations are very high in both groups (751.71 
for patients in the active state and 879.82 for 
those in remission), suggesting a large variability 
in individual values. This could indicate a 
heterogeneous distribution of FC levels within 
each group. 
 
Despite this difference in means, the comparison 
between the two groups does not reveal a 
statistically significant difference (P=0, 73)   
(Table 14). 

 

Table 11. FC Results according to different locations in crohn's disease 
 

 Ileal localization  Ileocolic localization Colonic localization 

Positive FC 10(47,62%) 3(23,1) 7(50%) 
Negative FC 10(47,62%) 8(61,54%) 6(42,86%) 
Equivocal FC  1(4,8%) 2(15,38%) 1 (7,14%) 
P value  0,56 0,27 0,74 

 

Table 12. CRP results according to different locations in crohn's disease 
 

 Ileal localization Ileocolic localization Colonic localization 

CRP≥6 mg/l 8(38,1%) 5(38,46%) 9(64,29%) 
CRP <6 mg/l 13(61,9%) 8(61,54%) 5(35,71%) 
P value 0,58 0,67 0,06 

 

Table 13. Comparison of the average rate of FC between CD and UC during Flare-Up 
 

 IBD N Mean (mg/kg) Standard Deviation 

FC UC 14 531,11 780,1 
CD 24 249,88 326,24 

Student's t-test P=0,09 
 

Table 14. Comparison of the Mean FC levels between active and remission states in UC 
 

 Clinical status N Mean (mg/Kg) Standard Deviation 

FC In a flare-up 14 531 751,71 
In remission 10 412,6 879,82 

Student's t-test P=0,73 



 
 
 
 

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3.3.3 Comparison of the Mean FC levels  
between active and remission states in 
CD 

 
The mean FC levels are very close between the 
two groups: 250 mg/L during the active phase 
and 258 mg/L in remission. However, the 
standard deviations reveal greater variability in 
the remission group (555.53) compared to the 
active group (320), indicating that the FC values 
are more dispersed among patients in remission. 
 
The Student's t-test indicates that there is no 
statistically significant difference between the 
mean FC levels based on clinical status (P=0, 
95). (Table 15) 
 
3.3.4 Comparison of the Mean CRP levels 

between CD and UC during the active 
phase 

 
The Student's t-test yielded a P-value of 0.88, 
indicating that the difference between the mean 
CRP levels of the two groups is not statistically 
significant. (Table 16) 
 

3.3.5  Comparison of the Mean CRP levels 
between active and remission states in 
UC 

 

The difference between the mean CRP levels in 
the two clinical states is statistically significant 
(P=0.03). (Table 17) 
 

3.3.6  Comparison of the Mean CRP levels 
between active and remission states in 
CD 

 

Patients in the "active" state have a slightly 
higher mean CRP level (19.62 mg/L) compared 
to those "in remission" (12.06 mg/L). However, 
the Student's t-test (P = 0.37) indicates that this 
difference is not statistically significant. (Table 
18) 
 

3.3.7 Comparison of the Mean FC levels 
according to disease location in CD 

 

Although there are differences in the mean fecal 
calprotectin (FC) levels based on the location of 
the disease (ileal, ileocolonic, colonic), these 
differences are not statistically significant (P=0, 
53). (Table 19) 

Table 15. Comparison of the Mean FC levels between active and remission states in CD 
 

 Clinical status N Mean (mg/Kg) Standard Deviation 

FC In a flare-up 24 250 320 
In remission 29 258 555,53 

Student's t test P=0,95 

 
Table 16. Comparison of the Mean CRP levels between CD and UC during the active phase 

 

 IBD N Mean (mg/L) Standard Deviation 

CRP UC 14 18,12 15,76 
CD 24 19,7 38,88 

Student's t-test P=0,88 

 
Table 17. Comparison of the Mean CRP levels between active and remission states in UC 

 

 Clinical status N Mean (mg/L) Standard Deviation 

CRP In a flare-up 13 17,73 15,54 

In remission 7 6,84 5,76 

Student's t-test P=0,03 

 
Table 18. Comparison of the Mean CRP levels between active and remission states in CD 

 

 Clinical status N Mean (mg/L) Standard Deviation 

CRP In a flare-up 24 19,62 38,12 

In remission 29 12.06 14,63 

Student's t-test P=0,37 

 
 



 
 
 
 

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Table 19. Comparison of the Mean FC levels among different locations in CD 
 

 Ileal localization Ileocolic localization Colonic localization 

Mean FC  rate (mg/kg) 269,13 127,40 403,21 
Standard Deviation 325,9 146,84 843,10 
ANOVA test P= 0,53 

 
Table 20. Comparison of the Mean CRP levels among different locations in CD 

 

 Ileal localization Ileocolic localization Colonic localization 

Mean CRP rate (mg/l) 7,99 13,44 20,67 
Standard Deviation 11,1 13,15 23,82 
ANOVA  test                               P=0,38 

 
3.3.8 Comparison of the Mean CRP levels 

According to disease location in CD 
 

Although there are differences in the mean CRP 
levels based on the location of the disease (ileal, 
ileocolonic, colonic), these differences are not 
statistically significant (P=0, 38). (Table 20) 
 

3.4 Correlation Test between FC and CRP 
during the active phase 

 

The correlation between CRP and FC is weak 
and positive (r = 0.12). This means that as the 

FC variable increases, CRP tends to increase as 
well, but only very slightly. However, since P = 
0.48, this correlation is not statistically significant. 
 
In practical terms, this indicates that CRP and FC 
should be used complementarily and not 
interchangeably to assess inflammation in adult 
patients with inflammatory bowel disease (IBD). 
A low CRP does not necessarily indicate low 
intestinal inflammation, highlighting the 
importance of measuring FC for an accurate 
evaluation. (Fig. 3). 

 

 
 

Fig. 3. Scatter Plot of correlation between FC and CRP during the active phase 
 

Spearman correlation test                  P= 0,48 
                 r=0,12 

 
 



 
 
 
 

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4. DISCUSSION 
 

4.1 Description of the Studied Population 
 
Inflammatory Bowel Diseases (IBD) do not 
appear to have a gender preference (Cosnes et 
al., 2011). However, according to Delmondes LM 
and al., a general female predominance has 
been observed in IBD cases, with a male-to-
female ratio of 0.641 (Lm et al., 2015). A cohort 
study conducted in Canada in 2017 involving 
45567 patients showed similar results. Lima 
Martins and  al. also reported this finding in their  
study in 2018 (Benchimol et al., 2017 ; LM et al., 
2018). Conversely, a study by Wang ZZ and al. 
in 2017 highlighted a male predominance in IBD 
cases (Jm et al., 2018). 
 
In a German study, the peak incidence for both 
Crohn's Disease (CD) and Ulcerative Colitis (UC) 
was observed in patients aged 30 years or 
younger (Kostev et al., 2018). The average age 
in the Oranian study was reported as 31.2 ± 3.4 
years (Masson, 2024).  
 
 In a study by Huguet J and al. in 2018, nearly 
69% of patients were over 60 years old (Jm et 
al., 2018).  
 
 In our series, the mean age was 39.7 years ± 
17.47 years. 
 
In a Moroccan study, CD accounted for 46.67% 
of cases (IBD , n.d.). In our series, we noted a 
clear predominance of CD, comprising 68.9% of 
cases. CD can affect any part of the 
gastrointestinal tract but shows a preference for 
the ileocecal region. The Montreal classification 
is widely used by gastroenterologists for lesion 
topography (Satsangi et al., 2006).  
 
 According to literature data, the small intestine 
and colon are preferred sites for CD. 
 
In our case series of CD, ileal localization was 
the most common, representing 39.62% of 
cases, followed by colonic localization at 26.41%. 
The observed differences may be linked to 
geographical, environmental, or genetic factors 
influencing the presentation of IBD. 
 
Fistulas are among the most frequently 
encountered complications in CD (Management 
of acute ano-perineal Crohn’s disease, 2024).  
 
Our results suggest that obstructive 
presentations are more common in patients with 

CD, with a statistically significant difference (P= 
0.04). This discrepancy with existing literature 
may arise from geographical variations, access 
to care, or differences in follow-up and treatment 
practices. 
 
A Dutch population study by Smids C and al. 
found that 44% of patients with CD smoked, 
compared to 20% with Crohn's Disease 
Indeterminate (CDI) and 7% with UC (Smids et 
al., 2017).  
 
 Among our patients, 5.3% were smokers, all 
diagnosed with CD. Our findings do not align with 
the literature and may be biased due to our small 
sample size; however, smoking appears more 
prevalent in CD cases than in UC. 
 
According to research by Casellas F and al., 
studying disease activity among a population of 
117 IBD patients, among those with CD, six 
subjects experienced at least one relapse 
compared to 58 who were in remission. For UC 
cases, four patients had relapses while 49 
showed no disease activity  (Nahon et al., 2018). 
  
 In our series, 38 patients (49.35%) were 
experiencing flare-ups, with 31.17% having CD. 
The increase in flare-ups within our series may 
be attributed to the small sample size.  
 
A Moroccan study reported abdominal pain in 20 
patients with CD (33.3%) and in 14 patients with 
UC (23.3%). False needs were reported in 32 
patients (53.3%), including ten with CD (16.67%) 
and twenty-one with UC (35%). Rectal bleeding 
was noted in 25% of patients with UC (IBD, n.d.).  
 
In our series, digestive manifestations were 
dominated by abdominal pain in 51.95% of 
patients with CD and in 19.48% of those with UC. 
Chronic diarrhea was present in 45.45% of CD 
cases and in 19.48% of UC cases; rectal 
bleeding occurred in 19.48% of cases (14.28% 
with UC), and false needs were reported in 
9.09% of cases (7.79% with CD). These results 
are consistent with literature data. 
 
An Iranian study conducted by Zobeiri M and al. 
highlighted that extra-digestive symptoms were 
marked by musculoskeletal signs (51.9%), 
followed by ocular signs (27.9%), and skin signs 
(22.7%) (Gao et al., 2017).  
 
In our study, articular signs were present in 
41.55% of patients; ocular manifestations 
occurred in 10.4%, and skin signs were seen in 



 
 
 
 

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3.9%. Our results align well with those reported 
in other studies. 
 

4.2 Results of FC and CRP testing 
 
In a Chinese study, CRP levels were found to be 
higher among patients with CD (Wang et al., 
2013).  
 
In our series, 34 patients (46.57%) had CRP 
levels ≥6 mg/L (with 29.87% having CD). Our 
findings are consistent with existing literature. 
 
Schoepfer and al. reported a higher correlation 
between the endoscopic activity of UC and FC 
levels (r = 0.8) compared to CRP (r = 0.5) 
(Schoepfer et al., 2024). A study conducted at 
the gastroenterology clinic of RSUD Dr. Soetomo 
Hospital in Surabaya from March to August 2020 
included 30 participants with UC. This cross-
sectional analytical study aimed to evaluate 
colitis activity through CRP and FC 
measurements. During flare-ups, FC was 
positive in 20 patients (67%), while CRP was 
positive in 13 patients (43%). A significant 
relationship was observed between FC and CRP, 
with a correlation coefficient (r) of 0.57 (P = 0.01) 
(Anindita et al., 2023).  
 
In our study, patients in flare had a higher 
proportion of positive FC (52.63%) compared to 
patients in remission (35.9%), and none of the 
patients in flare had equivocal FC results. This 
difference was confirmed by a P-value of 0.018, 
indicating a significant association between flare 
status and FC levels.  
 
Our results suggest that although there are 
differences in FC between flare and remission 
phases, these are not statistically significant with 
a P-value of 0.1 for patients with CD and UC. 
Furthermore, the comparison between CD and 
UC during flare phases yielded a P-value of 0.27, 
which is also not significant. This supports the 
notion that FC is a good biomarker for 
inflammation in the context of inflammatory 
bowel diseases (IBD), consistent with previous 
studies. 
 
A study conducted between 2018 and 2019 
involving 49 patients with CD and 31 healthy 
controls recruited from the gastroenterology and 
hepatology department at the University Hospital 
in Krakow, Poland, found significantly higher 
serum CRP levels in the CD group compared to 
the control group. Additionally, in patients with 
CD, serum CRP concentrations were markedly 

higher during active disease than during inactive 
disease (Słowińska-Solnica et al., 2021).  
 
A study conducted in 2006 in Italy, in 76 IBD 
patients (29 CD and 47 UC) fecal calprotectin 
has been evaluated by a commercial ELISA kit. 
Results demonstrate that levels of this protein in 
the stool are significantly more elevated in active 
CD and UC patients than in normal volunteers. 
Moreover, in CD patients levels of calprotectin 
are higher than in UC (Amati et al., 2006).  
 
Our results reveal no significant link between 
flare status (flare or non-flare) and CRP levels 
(<6 and ≥6) (P = 0.48). In CD patients, no 
significant difference in CRP was observed 
between flare and remission phases (P = 0.8). 
For UC, a trend towards a difference was noted, 
although it was not statistically significant (p = 
0.08).  
 
Differences in disease location in CD may 
account for some of the inter-individual variation 
in FC. However, FC and other stool biomarkers 
have been found to have low sensitivity in 
detecting isolated small bowel involvement seen 
on wireless capsule endoscopy (Sands, 2015).  
 
Gecse and al. demonstrated that patients with 
large ulcerations (>5 mm) in the ileum had 
significantly lower FC concentrations compared 
to those with ileocolonic or colonic disease (297 
vs. 1,523 μg/g, P < 0.0001). 
 
A study involving 120 patients with CD examined 
disease activity using biological markers as well 
as endoscopic and radiographic methods. FC 
concentration was measured in stool samples. 
Among these patients, 45% had ileocolonic CD, 
36.5% had small bowel CD, and 18.5% had 
colonic CD. In small bowel CD patients, FC was 
significantly correlated with CRP (P = 0.03), 
endoscopic activity (P < 0.0001), and 
radiographic assessment (P = 0.03). Similarly, in 
colonic CD patients, FC correlated with CRP (P = 
0.0009) and endoscopic activity (P = 0.0002). 
However, among small bowel CD patients, the 
Crohn's Disease Activity Index (CDAI) and 
inflammatory markers were not correlated with 
endoscopic and radiographic evaluations. 
 
For ileocolonic CD patients, FC showed a 
significant correlation with endoscopy (P=0.006), 
radiographic assessment (P = 0.04), CDAI (P = 
0.0006), as well as most biological markers. The 
concentration of FC reflects inflammatory activity 
more accurately in patients with lesions in both 



 
 
 
 

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the small intestine and colon compared to those 
with isolated small bowel disease (Sands, 2015).  
 
A study involving 273 CD patients, including 41 
with ileal disease and 189 with ileocolonic 
disease, showed that FC was significantly 
correlated with CDAI; correlation coefficients 
were 0.711 for ileal disease patients and 0.687 
for ileocolonic disease patients (Gecse et al., 
2015).  
  
 In our study, although there are differences in 
average FC levels based on disease location 
(ileal, ileocolonic, colonic), these differences are 
not statistically significant, possibly due to 
sample size or individual variations. 
 
According to a study including 88 patients with 
an average age of 34±10.8 years, twelve (13.6%) 
had negative CRP results. While location did not 
serve as a significant predictor, all patients with 
negative CRP had ileal involvement (Stawczyk-
Eder et al., 2015).  
 
In our study, results indicate no statistically 
significant difference between CRP levels (≥6 or 
<6) for ileal and ileocolonic locations; however, 
there is a suggestive trend for colonic location 
with a P-value of 0.06. 
 
There is an emphasis on the similarity regarding 
the absence of significant predictors related to 
location, suggesting that despite variations 
across studies, there is a general trend indicating 
that ileal location does not appear to be strongly 
correlated with CRP levels. 
 

4.3 Comparison Between the Average 
Levels of FC / CRP 

 
In a prospective study involving patients recruited 
from the inflammatory bowel disease unit at the 
University Hospital of Saint Etienne between 
June 2017 and June 2018, patients were 
followed for 12 months or until relapse. The 
measurement of FC and CRP showed that 
median FC levels progressively increased in 
patients who relapsed during the follow-up 
period, rising from 26 µg/g at baseline to 105 
µg/g at three months, 177 µg/g at six months, 
and 292 µg/g at the time of relapse (p = 0.049 
between baseline and relapse) 1. 
 
Serum CRP levels fluctuated during follow-up, 
but a significant difference in median CRP levels 
was observed between baseline and relapse (1.5 
mg/L vs. 3.3 mg/L, respectively; P = 0.008). 

However, median CRP levels remained normal 
below 5 mg/L (Li et al., 2023).  
 
A study involving twenty-six patients with 
inflammatory bowel disease, including five with 
Crohn's disease and twenty-one with ulcerative 
colitis, revealed no significant correlation 
between FC and CRP (r = 0.2) (Sousa et al., 
2017). 
 
In another observational prospective study of 
fifty-nine patients with ulcerative colitis, eighteen 
patients (30.5%) exhibited signs of active 
histological inflammation. These patients had a 
significantly higher median FC level (278 µg/g), 
while the average CRP level was 16 mg/L 
(Veyrard et al., 2022). 
 
A study conducted on 273 patients with Crohn's 
disease at the gastroenterology division of Tongji 
Medical College in Wuhan, China, found median 
FC levels in patients in endoscopic remission, 
mildly active, and moderately to severely active 
stages to be 26.94, 66.77, and 327.22 µg/g 
respectively, with significant differences 
observed (P < 0.001). Median CRP levels in 
clinically remission, mildly active, and moderately 
to severely active groups were respectively 3.30, 
6.30, and 30.30 mg/L (Gecse et al., 2015). 
 
In our study, the average FC level in patients 
with active Crohn's disease was 250 µg/g, while 
it was 258 µg/g in remission. Average CRP 
levels were 19 mg/L during flare-ups and 12 
mg/L in remission. This difference may be 
attributed to individual variability in inflammatory 
response or the presence of confounding factors 
such as the use of immunosuppressive 
medications. 
 
A separate study on fifty patients with ulcerative 
colitis aged between twelve and seventy-four 
years measured FC and CRP levels based on 
disease severity. Patients with mild activity had 
an average FC level of 207.46 g/kg and an 
average CRP level of 11.37 mg/L; those with 
moderate to severe activity had an average FC 
level of 729.85 g/kg and an average CRP level of 
29.38 mg/L. A statistically significant difference 
was observed between the two groups for both 
FC (P = 0.001) and CRP (P= 0.0001), indicating 
that both markers increase significantly with the 
severity of ulcerative colitis (Kyle et al., 2021). 
 
Rodriguez-Moranta and al. found that FC is 
better correlated with the degree of inflammation 
than other clinical indicators and serological 



 
 
 
 

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markers (Guardiola et al., 2014). Moreover, it 
could also be useful for predicting mucosal 
healing and the risk of relapse. 
 
According to a study by Mohamed and al., there 
was a highly significant increase in average FC 
values among active ulcerative colitis patients 
compared to inactive ones; similarly, there was a 
significant increase in average FC values among 
inactive ulcerative colitis patients compared to 
controls (Ahmed et al., 2017).  
 
In our study, the average FC level among 
patients with active ulcerative colitis was found to 
be 531 µg/g while it was 412.6 µg/g in remission. 
The Student's t-test yielded a non-significant p-
value of 0.73 for comparing these two groups 
regarding FC levels. Average CRP levels were 
found to be 17.73 mg/L during flare-ups and 6.84 
mg/L in remission; the Student's t-test yielded a 
significant P-value of 0.03 when comparing the 
two groups for CRP. 
 
A retrospective analysis of records from 
inflammatory bowel disease patients followed 
between January 2012 and October 2014 at a 
gastroenterology care center in Mumbai included 
sixty-three patients (32 with ulcerative colitis and 
31 with Crohn's disease). Erythrocyte 
sedimentation rate (ESR), CRP, and FC were 
compared against endoscopic results to evaluate 
inflammation. 
 
Patients with ulcerative colitis exhibited higher 
FC levels than those with ileocolic Crohn's 
disease (median FC: 1800 mg/g vs. 619 mg/g; P 
= 0.04). Additionally, FC levels were correlated 
with CRP (r = 0.4; P < 0.001). Among the sixty-
three patients showing signs of inflammation 
upon endoscopic examination, a higher 
proportion (86.9%) had positive FC 
concentrations compared to those showing 
positive CRP results (65.6%; P < 0.01) 
(Rodríguez-Moranta et al., 2013). 
 
In our study, average FC levels were higher in 
ulcerative colitis than in Crohn's disease; 
however, these results did not significantly 
distinguish between ulcerative colitis and Crohn's 
disease concerning FC levels. The Student's t-
test applied to average CRP levels yielded a P-
value of 0.88, indicating no statistically significant 
difference between the average CRP levels of 
both groups. 
 
Finally, the correlation between CRP and FC was 
weakly positive (r = 0.12; P = 0.48). Previous 

studies have shown that both FC and CRP 
significantly increase in correlation with 
inflammation severity; however, our analysis 
reveals a weak and non-significant correlation 
within our cohort (r = 0.12; P = 0.48). This 
suggests that within our cohort, CRP and FC do 
not act together to reflect inflammation effectively 
(Badawy et al., 2014;Samant et al., 2015). 
 

5. CONCLUSION AND PERSPECTIVES 
 
Our study has provided a clearer definition of the 
clinical and epidemiological profile of 
inflammatory bowel diseases (IBD) in adults, 
highlighting the distinctive characteristics of 
Crohn's disease (CD) and ulcerative colitis (UC). 
The results indicate a higher prevalence of IBD 
among adult women. In terms of biomarkers, C-
reactive protein (CRP) and final concentration 
(FC) have proven relevant for monitoring 
intestinal inflammation, with significantly elevated 
levels of FC during flare-ups, confirming its utility 
as an inflammation indicator. However, the 
absence of a significant correlation between FC 
and CRP during flare-ups suggests that these 
biomarkers reflect distinct aspects of 
inflammation. 
 
An integrated assessment, combining these 
biomarkers with clinical scores and imaging, 
remains essential for optimal monitoring. In 
conclusion, this study highlights clinical and 
biological differences based on the type of IBD, 
the location of lesions (ileal, ileocolic, or colonic), 
and the nature of complications, emphasizing the 
importance of a personalized approach to 
managing IBD that incorporates specific 
biomarkers (CRP, FC) and patient profiles. 
Larger comparative studies exploring genetic and 
environmental factors are necessary to refine 
diagnostic tools and further tailor treatments. 
Additional research will help validate these 
findings and optimize clinical follow-up protocols 
for more precise and tailored care. 
 

DISCLAIMER (ARTIFICIAL INTELLIGENCE) 
 
Author(s) hereby declare that NO generative AI 
technologies such as Large Language Models 
(ChatGPT, COPILOT, etc) and text-to-image 
generators have been used during writing or 
editing of this manuscript. 
 

CONSENT AND ETHICAL APPROVAL  
 
Informed consent was obtained from all 
participants after they were fully informed about 



 
 
 
 

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the study’s objectives, procedures, and 
measures to ensure confidentiality and data 
protection. The study protocol was conducted in 
accordance with ethical standards. 
 

ACKNOWLEDGEMENTS 
 
The authors are grateful to all the subjects who 
helped finalize the study. 

 
COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 

REFERENCES 
 
Ahmed, R., El-Atreb, K. A., Hassan, A., Haydara, 

T., Abo-Amer, Y., & Abd-Elsalam, S. 
(2017). fecal calprotectin and CRP as 
biochemical markers in predicting 
inflammatory bowel disease activity in 
patients with ulcerative colitis. Int J Med 
Res, 38(1), 10-5. 

Amati, L., Passeri, M. E., Selicato, F., 
Mastronardi, M. L., Penna, A., Jirillo, E., & 
Covelli, V. (2006). New insights into                  
the biological and clinical significance                       
of fecal calprotectin in inflammatory           
bowel disease. Immunopharmacology and 
Immunotoxicology, 28(4), 665-681. 
Available:https://www.tandfonline.com/doi/
abs/10.1080/08923970601067326 

Anindita, B., Sugihartono, T., Miftahussurur, M., 
Maimunah, U., Nusi, I. A., Setiawan, P. B., 
et al. (2023). High levels of fecal 
calprotectin and C-reactive protein in 
patients with colitis. J Med Life, 16(1), 48–
51. 

Badawy, A. M., Nouh, M. A., Ali, A. E., El Halim, 
E. M., Mohamed, H. I., & El Ghany, A. M. 
(2014). Calprotectin as a fecal marker for 
diagnosis and follow-up in patients with 
ulcerative colitis. Menoufia Med J, 27(1), 
35. 

Benchimol, E. I., Kaplan, G. G., Otley, A. R., 
Nguyen, G. C., Underwood, F. E., 
Guttmann, A., et al. (2017). Rural and 
urban residence during early life is 
associated with risk of inflammatory bowel 
disease: A population-based inception and 
birth cohort study. Am J Gastroenterol, 
112(9), 1412–1422. 

Cosnes, J., Gower-Rousseau, C., Seksik, P., & 
Cortot, A. (2011). Epidemiology and 
natural history of inflammatory bowel 

diseases. Gastroenterology, 140(6), 1785–
1794. 

D’Amico, F., Rubin, D. T., Kotze, P. G., Magro, 
F., Siegmund, B., Kobayashi, T., et al. 
(2021, May). International consensus on 
methodological issues in standardization of 
fecal calprotectin measurement in 
inflammatory bowel diseases. United 
European Gastroenterol J, 9(4), 451–460. 

Gao, Y., Khan, S., Akerman, M., & Sultan, K. 
(2017). Analysis of the clinical indications 
for opiate use in inflammatory bowel 
disease. Intestinal research, 15(1), 83-89. 
Available:https://pmc.ncbi.nlm.nih.gov/articl
es/PMC5323312/ 

Gecse, K. B., Brandse, J. F., van Wilpe, S., 
Löwenberg, M., Ponsioen, C., van den 
Brink, G., et al. (2015). Impact of disease 
location on fecal calprotectin levels in 
Crohn’s disease. Scand J Gastroenterol, 
50(7), 841–847. 

Guardiola, J., Lobatón, T., Rodríguez-Alonso, L., 
Ruiz-Cerulla, A., Arajol, C., Loayza, C., et 
al. (2014). Fecal level of calprotectin 
identifies histologic inflammation in patients 
with ulcerative colitis in clinical and 
endoscopic remission. Clin Gastroenterol 
Hepatol, 12(11), 1865–1870. 

Immunoclinical profile of inflammatory bowel 
diseases (IBD). 

Jm, H., M I, Mm, B. W., N, M., R, G., X, C., et al. 
(2018). Inflammatory bowel disease in 
patients over the age of 70 years: Does the 
disease duration influence its behavior? 
Scand J Gastroenterol, 53(9).  
Available:https://pubmed.ncbi.nlm.nih.gov/
30189153/ 

Kostev, K., Konrad, M., & Jacob, L. (2018). Time 
between suspected and confirmed 
diagnoses of Crohn’s disease and 
ulcerative colitis in patients followed in 
gastroenterological practices in Germany. 
Int J Colorectal Dis, 33(7), 967–971. 

Kyle, B. D., Agbor, T. A., Sharif, S., Chauhan, U., 
Marshall, J., Halder, S. L. S., et al. (2021). 
Fecal calprotectin, CRP, and leukocytes in 
IBD patients: Comparison of biomarkers 
with biopsy results. J Can Assoc 
Gastroenterol, 4(2), 84–90. 

Li, J., Xu, M., Qian, W., Ling, F., Chen, Y., Li, S., 
... & Zhu, L. (2023). Clinical value of fecal 
calprotectin for evaluating disease activity 
in patients with Crohn’s disease. Frontiers 
in Physiology, 14, 1186665. 

LM, A., Ra, V., & Mdp, Z. G. (2018). The 
prevalence and phenotype in Brazilian 

https://www.tandfonline.com/doi/abs/10.1080/08923970601067326
https://www.tandfonline.com/doi/abs/10.1080/08923970601067326
https://pmc.ncbi.nlm.nih.gov/articles/PMC5323312/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5323312/
https://pubmed.ncbi.nlm.nih.gov/30189153/
https://pubmed.ncbi.nlm.nih.gov/30189153/


 
 
 
 

Nassar et al.; Asian J. Immunol., vol. 8, no. 1, pp. 104-119, 2025; Article no.AJI.135189 
 
 

 
118 

 

patients with inflammatory bowel disease. 
BMC Gastroenterology, 18(1).  
Available:https://pubmed.ncbi.nlm.nih.gov/
29914399/ 

Lm, D., Mo, N., Ar, A., Mm, O., Le, C., & Jd, T. N. 
(2015). Clinical and sociodemographic 
aspects of inflammatory bowel disease 
patients. Gastroenterology Research, 8(3–
4).  
Available:https://pubmed.ncbi.nlm.nih.gov/
27785298/ 

Ma, C., Battat, R., Khanna, R., Parker, C. E., 
Feagan, B. G., & Jairath, V. (2019). What 
is the role of C-reactive protein and fecal 
calprotectin in evaluating Crohn’s disease 
activity? Best Pract Res Clin 
Gastroenterol, 38–39, 101602. 

Management of acute ano-perineal Crohn’s 
disease localization (APL) – FMC-HGE. 
(2024).  
Available:https://www.fmcgastro.org/postu-
main/archives/postu-2010-paris/prise-en-
charge-dune-localisation-ano-perineale-
lap-de-crohn-a-sa-phase-aigue-2/ 

Masson, E. (2024). Epidemiological aspects of 
Crohn’s disease in the Oran region, 
Algeria. EM-Consulte.  
Available:https://www.em-
consulte.com/article/1075150/aspects-
epidemiologiques-de-la-maladie-de-crohn-
da 

Nahon, S., Ramtohul, T., Paupard, T., 
Belhassan, M., Clair, E., & Abitbol, V. 
(2018). Evolution in clinical presentation of 
inflammatory bowel disease over time at 
diagnosis: A multicenter cohort study. Eur 
J Gastroenterol Hepatol, 30(10), 1125–
1129. 

Rodríguez-Moranta, F., Lobatón, T., Rodríguez-
Alonso, L., & Guardiola, J. (2013). Fecal 
calprotectin in the diagnosis of 
inflammatory bowel diseases. 
Gastroenterol Hepatol, 36(6), 400–406. 

Samant, H., Desai, D., Abraham, P., Joshi, A., 
Gupta, T., Dherai, A., et al. (2015). Fecal 
calprotectin and its correlation with 
inflammatory markers and endoscopy in 
patients from India with inflammatory 
bowel disease. Indian J Gastroenterol, 
34(6), 431–435. 

Sands, B. E. (2015). Biomarkers of inflammation 
in inflammatory bowel disease. 
Gastroenterology, 149(5), 1275-1285.e2. 

Satsangi, J., Silverberg, M. S., Vermeire, S., & 
Colombel, J. F. (2006). The Montreal 
classification of inflammatory bowel 

disease: Controversies, consensus, and 
implications. Gut, 55(6), 749–753. 

Schoepfer, A. M., Beglinger, C., Straumann, A., 
Safroneeva, E., Romero, Y., Armstrong, 
D., Schmidt, C., Trummler, M., Pittet, V., & 
Vavricka, S. R. (2024) Fecal calprotectin 
more accurately reflects endoscopic 
activity of ulcerative colitis than the 
Lichtiger Index, C-reactive protein, 
platelets, hemoglobin, and blood 
leukocytes – PubMed. Available from: 
https://pubmed.ncbi.nlm.nih.gov/23328771
/ 

Słowińska-Solnica, K., Pawlica-Gosiewska, D., 
Gawlik, K., Owczarek, D., Cibor, D., 
Pocztar, H., ... & Solnica, B. (2021). Serum 
inflammatory markers in the diagnosis and 
assessment of Crohn’s disease activity. 
Archives of Medical Science: AMS, 17(1), 
252.  
Available:https://pmc.ncbi.nlm.nih.gov/artic
les/PMC7811324/ 

Smids, C., Horjus Talabur Horje, C. S., Groenen, 
M. J. M., van Koolwijk, E. H. M., Wahab, P. 
J., van Lochem, E. G. (2017). The value of 
serum antibodies in differentiating 
inflammatory bowel disease, predicting 
disease activity, and disease course in the 
newly diagnosed patient. Scand J 
Gastroenterol, 52(10), 1104–1112. 

Sousa, P., Martins, D., Pinho, J., Cancela, E., 
Cardoso, R., Araujo, R., ... & Ministro, P. 
(2017). P255 Predictors of negative C-
reactive protein in active Crohn's disease. 
Journal of Crohn’s and Colitis (ecco-jcc), 
11(suppl_1), S207-S208.  
Available:https://www.researchgate.net/pu
blication/313463358_P255_Predictors_of_
negative_C-
reactive_protein_in_active_Crohn's_diseas
e 

Stawczyk-Eder, K., Eder, P., Lykowska-Szuber, 
L., Krela-Kazmierczak, I., Klimczak, K., 
Szymczak, A., et al. (2015). Is fecal 
calprotectin equally useful in all Crohn’s 
disease locations? A prospective, 
comparative study. Arch Med Sci, 11(2), 
353–361. 

Swaminathan, A., & Day, A. S. (2024, August). 
Measures of gut inflammation in patients 
with inflammatory bowel disease: Are 
blood-based biomarkers sufficient? Dig Dis 
Sci, 69(8), 2723–2724. 

Torres, J., Mehandru, S., Colombel, J. F., & 
Peyrin-Biroulet, L. (2017). Crohn’s 
disease. Lancet, 389(10080), 1741–1755. 

https://pubmed.ncbi.nlm.nih.gov/29914399/
https://pubmed.ncbi.nlm.nih.gov/29914399/
https://pubmed.ncbi.nlm.nih.gov/27785298/
https://pubmed.ncbi.nlm.nih.gov/27785298/
https://www.fmcgastro.org/postu-main/archives/postu-2010-paris/prise-en-charge-dune-localisation-ano-perineale-lap-de-crohn-a-sa-phase-aigue-2/
https://www.fmcgastro.org/postu-main/archives/postu-2010-paris/prise-en-charge-dune-localisation-ano-perineale-lap-de-crohn-a-sa-phase-aigue-2/
https://www.fmcgastro.org/postu-main/archives/postu-2010-paris/prise-en-charge-dune-localisation-ano-perineale-lap-de-crohn-a-sa-phase-aigue-2/
https://www.fmcgastro.org/postu-main/archives/postu-2010-paris/prise-en-charge-dune-localisation-ano-perineale-lap-de-crohn-a-sa-phase-aigue-2/
https://www.em-consulte.com/article/1075150/aspects-epidemiologiques-de-la-maladie-de-crohn-da
https://www.em-consulte.com/article/1075150/aspects-epidemiologiques-de-la-maladie-de-crohn-da
https://www.em-consulte.com/article/1075150/aspects-epidemiologiques-de-la-maladie-de-crohn-da
https://www.em-consulte.com/article/1075150/aspects-epidemiologiques-de-la-maladie-de-crohn-da
https://pubmed.ncbi.nlm.nih.gov/23328771/
https://pubmed.ncbi.nlm.nih.gov/23328771/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7811324/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7811324/


 
 
 
 

Nassar et al.; Asian J. Immunol., vol. 8, no. 1, pp. 104-119, 2025; Article no.AJI.135189 
 
 

 
119 

 

Ulcerative colitis - PubMed. (2024, December 
28).  
Available:https://pubmed.ncbi.nlm.nih.gov/
27914657/ 

Veyrard, P., Roblin, X., Pansart, C., Mao, R., 
Nancey, S., Killian, M., ... & Paul, S. 
(2022). Serum calprotectin is useful to 
confirm inflammatory bowel disease 

activity but not to predict relapse. Clinical 
Immunology Communications, 2, 33-38. 

Wang, x. Q., zhang, y., xu, c. D., jiang, l. R., 
huang, y., du, h. M., et al. (2013). 
Inflammatory bowel disease in chinese 
children: a multicenter analysis over a 
decade from shanghai. Inflamm bowel dis, 
19(2), 423–428. 

 
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