Fecal Calprotectin During Treatment of Severe Infantile Colic With Lactobacillus reuteri DSM 17938: A Randomized, Double-Blind, Placebo-Controlled Trial
BACKGROUND AND OBJECTIVES:
Fecal calprotectin level has been reported to correlate with inflammation in inflammatory bowel disease in adults, and recently its relationship with infantile colic has also been described. Fecal calprotectin is elevated in infants with hematochezia and possible allergic colitis. The objectives were to evaluate fecal calprotectin at the time of enrollment and its variation after 3 weeks of therapy with a probiotic (Lactobacillus reuteri DSM 17938) in infants with severe infantile colic admitted to our hospital for either hematochezia, food allergy, or eczema. This study also aimed to compare fecal calprotectin values in infants with infantile colic and symptoms of food allergy with those in healthy infants.
Forty-three patients with severe infantile colic, diagnosed according to the Wessel definition, were prospectively enrolled; 25 received a probiotic and 18 received placebo. The study population was composed as follows: 23 (48%) boys, mean age at enrollment in the study 36.6 ± 11.9 days, 36 (75%) exclusively breastfed. At enrollment, mothers were told to avoid cow’s milk in their diet. Clinical responders after study period were considered infants who had reduced crying time per day and whose calprotectin decreased by ≥50% compared with baseline. We measured fecal calprotectin levels in fresh stools of these patients before and after 3 weeks of therapy by using the Quantum Blue Calprotectin Rapid Test (Bühlmann Laboratories AG, Schönenbuch, Switzerland). During treatment clinical symptoms were assessed by parents, who used a diary to record time of infantile crying per day and stool characteristics. A group of 19 healthy controls were enrolled only to provide calprotectin values for comparison.
Forty-three infants (L. reuteri group, 25; placebo group, 18) completed the trial. A sustained clinical response after treatment with probiotic was observed in 17 (65.4%) treated patients; the average values of fecal calprotectin were 601 μg/g after therapy versus 920 μg/g before induction (P < .05). Posttreatment fecal calprotectin was significantly lower in responders than in nonresponders (P = .012). The control group showed a mean calprotectin value of 100 μg/g, significantly different from that of the colicky group (P < .005).
The administration of L. reuteri DSM 17938 significantly decreases crying time and fecal calprotectin level. Colicky infants have significantly higher calprotectin levels than healthy controls. Finally, fecal calprotectin assay after probiotic treatment with L. reuteri DSM 17938 can be used to predict sustained clinical response and monitor gut health in infants.
- Copyright © 2015 by the American Academy of Pediatrics