Comparative Evaluation of Serum Hepcidin and Fecal Calprotectin for Disease Activity Assessment in Inflammatory Bowel Disease

Abstract

Background/Aims: Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic inflammatory disorder commonly associated with iron deficiency anemia and anemia of chronic disease. Hepcidin is a key regulator of iron homeostasis, increasing in response to inflammation and decreasing in iron deficiency. This study evaluated the relationship between serum hepcidin and fecal calprotectin levels and examined the potential role of hepcidin in assessing disease activity and differentiating anemia subtypes.

Materials and Methods: The study included 29 patients with IBD with active disease, 45 in remission, and 34 controls; all participants were evaluated at Başkent University Ankara Hospital in 2014. Complete blood count, serum hepcidin, ferritin, serum iron, total ironbinding capacity (TIBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were analyzed in all participants. Fecal calprotectin was additionally measured in patients.

Results: Hepcidin levels were significantly higher in patients with both active disease and in remission compared with controls (P < .05). Hepcidin levels were negatively correlated with hemoglobin, hematocrit, and ferritin and positive correlated with TIBC and ESR (P < .05). Fecal calprotectin levels were significantly higher in patients with active disease and were positively correlated with CRP and clinical activity scores (P < .01). However, no significant correlation was found between hepcidin and fecal calprotectin (P > .025).

Conclusion: Fecal calprotectin was strongly associated with disease activity, whereas hepcidin was not, suggesting that hepcidin may have limited utility for disease activity assessment. Hepcidin may primarily reflect systemic iron metabolism and anemia of inflammation. Further studies are needed to clarify its clinical role.

Cite this article as: Akıncıoğlu P, Dağlı ., Koca E. Comparative evaluation of serum hepcidin and fecal calprotectin for disease activity assessment in inflammatory bowel disease. Turk J Gastroenterol. 2026;37(7):757-764.