Abstract Background Managing inflammatory bowel disease (IBD) often requires ongoing assessment of how active the inflammation is and whether the bowel is healing. Although endoscopy remains the gold standard, it is invasive, time-consuming, and not always acceptable to patients who may already be undergoing multiple investigations. In routine clinical practice, clinicians increasingly rely on non-invasive tools, especially faecal calprotectin (FC), to monitor disease activity.However, FC is usually interpreted as a single number at a single point in time, which may not fully reflect the true disease course. Patients often experience fluctuations in symptoms, treatment changes, and varying degrees of inflammation, and a one-off FC value may miss these important dynamics. Methods We conducted a prospective observational study involving adult patients diagnosed with ulcerative colitis or Crohn’s disease who were under routine follow-up in our gastroenterology service. Patients were included if they required both faecal calprotectin (FC) assessment and endoscopic evaluation as part of their clinical care. Those with incomplete follow-up, recent gastrointestinal infections, or inability to provide stool samples were excluded to maintain consistency and reliability of results.All participants underwent FC testing at three time-points: at baseline (week 0), week 8, and week 16. Results A total of 142 patients were enrolled in the study, including 92 with ulcerative colitis and 50 with Crohn’s disease. The mean age was 41 years, and 56% were male. Baseline disease activity ranged from mild to severe, reflecting a typical real-world IBD cohort. All patients completed FC testing at the three scheduled time-points, and 128 (90%) underwent follow-up endoscopy at week 16.By the end of the 16-week period, 54% of patients achieved mucosal healing according to the predefined endoscopic criteria. Patients who went on to heal demonstrated a clear and early reduction in FC levels, with many showing a noticeable fall even before clinical symptoms improved. A reduction in FC of ≥ 50% by week 8 was strongly associated with mucosal healing at week 16 (p 0.001).When comparing different approaches to interpreting FC, the “trend-based” assessment consistently outperformed single threshold values. Conclusion Serial monitoring of faecal calprotectin provides a clearer and more clinically meaningful understanding of disease activity in IBD than isolated measurements. . This approach may reduce the need for repeated endoscopy, support earlier intervention, and encourage more proactive and personalised IBD management. Ultimately, FC trend analysis has the potential to improve long-term outcomes for individuals living with ulcerative colitis and Crohn’s disease. Reference: D’Haens G, Ferrante M, Vermeire S, et al. Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Gastroenterology. 2012;142(1):S145–S146. Conflict of interest: Mr. Meena, Amit Kumar: Grants, personal fees Hajare, Santosh: No conflict of interest
Meena et al. (Thu,) studied this question.