# The Impact of Proactive Fecal Calprotectin Collection in an Outreach Protocol for Biologic-Naïve Ulcerative Colitis Patients–Ulcerative Colitis Clinical Outreach (UCCO)

## TL;DR

A proactive outreach program for ulcerative colitis patients improved care by identifying hidden inflammation and guiding treatment changes.

## Contribution

Introduces a proactive outreach protocol that combines clinical and biochemical assessments to improve management of biologic-naïve UC patients.

## Key findings

- 55.6% of patients had their UC management changed based on protocol results.
- Fecal calprotectin and Sutherland Index scores predicted management escalations.
- 86.4% of gastroenterologists found the protocol helpful for patient care.

## Abstract

Background: Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease that requires regular monitoring. The University of Alberta IBD Unit piloted a proactive outreach protocol for biologic-naïve UC patients, including clinical and biochemical variables, and assessed its impact on UC care. Methods: Biologic-naïve UC patients without follow-up for ≥6 months were recruited by phone and completed Partial Mayo, modified Sutherland Index, and MARS-5 questionnaires, as well as blood work and fecal calprotectin (FCP). Results were sent to each patient’s gastroenterologist, who then completed a survey about intended UC management changes. Results: 81 patients completed the protocol. UC management was changed in 45 (55.6%) cases, with 82.2% of changes being expedited follow-up or management escalation. Six patients had active flares, and 17 with asymptomatic inflammation were identified. 23 patients underwent endoscopy, with 10 (43.4%) showing active disease. Six patients started biologic therapies based on protocol and endoscopic findings. UC management escalations were significantly predicted by FCP and Sutherland Index scores on logistic regression analysis. 86.4% of gastroenterologists rated the protocol helpful. Conclusions: Patient care can be improved by a one-time, proactive outreach program for biologic-naïve UC. Outreach and monitoring in biologic-naïve UC should include assessment of both FCP and clinical markers to improve UC management.