Feasibility and Clinical Utility of Home-Based Fecal Immunochemical Testing for Self-Monitoring of Disease Activity in Ulcerative Colitis

Background Home-based quantitative fecal calprotectin testing has been used to improve the prognosis of ulcerative colitis (UC) patients. However, its cost and the need for specific measurement devices limit accessibility. This study explored the potential of the home-based fecal immunochemical test (FIT) for self-monitoring in patients with UC. Methods In this prospective cohort study, we recruited patients in clinical remission who were scheduled for colonoscopy between October 2020 and October 2021. We evaluated the correlation between home-based qualitative FIT results obtained using a commercially available kit and hospital-based quantitative fecal markers, endoscopic activity, and treatment intensification. We also assessed the feasibility of continued home-based FIT. Results Among the 54 enrolled patients, 38 tested negative and 16 tested positive using the home-based FIT. The FIT-negative patients had significantly lower hospital-based FIT and fecal calprotectin levels than the FIT-positive patients (p < 0.0001 and p = 0.0029, respectively). The accuracy of home-based FIT for predicting endoscopic remission was 0.83, which was comparable to that of hospital-based FIT (0.85) and fecal calprotectin (0.79). None of the 38 FIT-negative patients required intensification of treatment. Among the 20 patients eligible for continued home-based FIT, the adherence rate over one year was 97.0% (82.1–100%). Notably, none of the eight FIT-negative patients experienced clinical relapse, whereas those with at least one FIT-positive showed a higher tendency for clinical relapse (p = 0.055). Conclusions Home-based FIT is a feasible, accurate, and well-accepted tool for monitoring remission in UC and is comparable to hospital-based fecal markers.