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AIM: To evaluate fecal calprotectin (FC) as a surrogate marker of treatment outcome of relapse of inflammatory bowel disease (IBD) and,to compare FC with fecal myeloperoxidase (MPO) and fecal eosinophil protein X (EPX).METHODS: Thirty eight patients with IBD,comprising of 27 with ulcerative colitis (UC) and 11 with Crohn's disease (CD) were investigated before treatment (inclusion),and after 4 and 8 wk of treatment.Treatment outcomes were evaluated by clinical features of disease activity and endoscopy in UC patients,and disease activity in CD patients.In addition,fecal samples were analyzed for FC by enzyme-linked immunosorbent assay (ELISA),and for MPO and EPX with radioimmunoassay (R/A).RESULTS: At inclusion 37 of 38 (97%) patients had elevated FC levels (＞94.7 μg/g).At the end of the study,31 of 38 (82%) patients fulfilled predefined criteria of a complete response [UC 21/27 (78%); CD 10/11 (91%)].Overall,a normalised FC level at the end of the study predicted a complete response in 100% patients,whereas elevated FC level predicted incomplete response in 30%.Normalised MPO or EPX levels predicted a complete response in 100% and 90% of the patients,respectively.However,elevated MPO or EPX levels predicted incomplete response in 23% and 22%,respectively.CONCLUSION: A normalised FC level has the potential to be used as a surrogate marker for successful treatment outcome in IBD patients.However,patients with persistent elevation of FC levels need further evaluation.FC and MPO provide superior discrimination than EPX in IBD treatment outcome.