Background: Endoscopic evaluation is considered the reference method for assessing inflammatory activity in inflammatory bowel disease (IBD) [1]. Nevertheless, the invasive nature and cost of repeated endoscopic procedures limit their use for frequent monitoring in routine clinical practice [2]. In this context, non-invasive biomarkers such as C-reactive protein (CRP) and fecal calprotectin (FC) have been increasingly used to estimate intestinal inflammatory activity [3]. Aim: To examine the relationship between CRP, fecal calprotectin, and endoscopic disease activity in patients with IBD, and to determine the diagnostic performance of their combined use. Methods: This cross-sectional observational study included 180 adult patients with confirmed IBD who underwent recent endoscopic evaluation along with concomitant measurements of CRP and fecal calprotectin. Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn’s Disease (SES-CD) for Crohn’s disease and the Mayo endoscopic subscore for ulcerative colitis. Associations between biomarker levels and endoscopic scores were analyzed using Spearman’s rank correlation coefficient. Results: A total of 180 patients were included, of whom 120 had Crohn’s disease, and 60 had ulcerative colitis. Fecal calprotectin demonstrated strong correlations with endoscopic activity in Crohn’s disease (r = 0.74, p < 0.001) and ulcerative colitis (r = 0.69, p < 0.001). In comparison, CRP showed moderate correlations with endoscopic severity (r = 0.48 and r = 0.42, respectively). The combined evaluation of CRP and fecal calprotectin improved the identification of moderate-to-severe endoscopic inflammation, with a sensitivity of 88% and a specificity of 76%. Conclusion: Fecal calprotectin shows a strong association with endoscopic disease activity and appears to be more informative than CRP for reflecting mucosal inflammation in patients with IBD.
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