Faecal calprotectin—ready for prime time?

Journal of Crohn's and Colitis, 2014

Background: Distinguishing inflammatory bowel disease (IBD) from functional gastrointestinal (GI) disease remains an important issue for gastroenterologists and primary care physicians, and may be difficult on the basis of symptoms alone. Faecal calprotectin (FC) is a surrogate marker for intestinal inflammation but not cancer. Aim: This large retrospective study aimed to determine the most effective use of FC in patients aged 16-50 presenting with GI symptoms. Methods: FC results were obtained for patients presenting to the GI clinics in Edinburgh between 2005 and 2009 from the Edinburgh Faecal Calprotectin Registry containing FCs from >16,000 patients. Case notes were interrogated to identify demographics, subsequent investigations and diagnoses. Results: 895 patients were included in the main analysis, 65% female and with a median age of 33 years. 10.2% were diagnosed with IBD, 7.3% with another GI condition associated with an abnormal GI tract and 63.2% had functional GI disease. Median FC in these three groups were 1251, 50 and 20 μg/g (p < 0.0001). On ROC analysis, the AUC for FC as a predictor of IBD vs. functional disease was 0.97. Using a threshold of ≥ 50 μg/g for IBD vs. functional disease yielded a sensitivity of 0.97, specificity of 0.74, positive predictive value of 0.37 and negative predictive value of 0.99. Combined with alarm symptoms, the sensitivity was 1.00. Conclusions: Implementation of FC in the initial diagnostic workup of young patients with GI symptoms, particularly those without alarm symptoms, is highly accurate in the exclusion of IBD, and can provide reassurance to patients and physicians.

Journal of Clinical Pathology, 2017

BackgroundFaecal calprotectin (FC) measurement distinguishes patients with inflammatory bowel disease (IBD) from those with irritable bowel syndrome but evidence of its performance in primary care is limited.AimsTo assess the yield of IBD from FC testing in primary care.MethodsRetrospective review of hospital records to assess the outcome following FC testing in primary care. Investigations for all patients undergoing FC testing in a single laboratory for 6 months from 1 October 2013 to 28 February 2014 were reviewed.Results410 patients (162 male; median age 42; range 16–91) were included. FC&gt;50 µg/g was considered positive (FC+). 148/410 (36.1%; median age 44 (17–91)) were FC+ (median FC 116.5 µg/g (51–1770)). 122/148 FC-positive patients (82.4%) underwent further investigation. 97 (65.5%) underwent lower gastrointestinal endoscopy (LGIE), of which 7 (7.2%) had IBD. 49/262 (18.7%) FC-negative (FC−) patients (FC ≤50 µg/g) (median age 47 (19–76)) also underwent LGIE, of whom 3 (6....

Canadian journal of gastroenterology & hepatology, 2016

Objectives. To determine the relationship between fecal calprotectin (FCAL) and imaging studies and other biochemical inflammatory markers and the impact of FCAL measurements on decision-making in IBD patient management in usual clinical practice. Methods. 240 persons with IBD were enrolled. The correlation between FCAL values and other markers for disease activity such as serum albumin (alb), hemoglobin (Hg), and C-reactive protein (CRP) and diagnostic imaging or colonoscopy was examined. FCAL ≥ 250 mcg/g of stool was considered a positive result indicating active IBD. Results. 183 stool samples (76.3%) were returned. The return rate in the pediatric and adult cohorts was 91% (n = 82) and 67.3% (n = 101), respectively (P &lt; 0.0001). Positive FCAL was associated with colonoscopy findings of active IBD (P &lt; 0.05), low albumin (P &lt; 0.05), anemia (P &lt; 0.01), and elevated CRP (P &lt; 0.01). There was no significant difference for FCAL results by outcomes on small bowel evalua...

Caspian journal of internal medicine, 2017

Inflammatory bowel disease (IBD) involves chronic inflammation of the digestive tract. In the past decades, fecal calprotectin has been proposed as a useful biomarker for the differential diagnosis between IBD patients and healthy controls. We designed this study to evaluate the diagnostic ability of fecal calprotectin (FC) and conventional inflammatory markers in IBD patients. Thirty patients who underwent colonoscopy were cases and thirty healthy subjects undergoing colonoscopy as part of a medical check-up were the controls. These 2 groups were evaluated with regard to age and sex. Severity of the disease was evaluated based on disease endoscopic index. FC, Cross reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were measured using ELISA, colorimetric and Westergren methods, respectively. The obtained data were analyzed by independent test, correlation test and receiver operating characteristic (ROC) curve analysis. A p&lt;0.05 was considered statistically significa...

2003

Background: Fecal calprotectin (FC) has been proposed as a marker of inflammatory bowel disease (IBD), but few studies have evaluated its usefulness in patients with chronic diarrhea of various causes. We evaluated the diagnostic accuracy of a FC assay in identifying "organic" causes of chronic diarrhea in consecutive adults and children. Methods: We consecutively enrolled 70 adult patients (30 males, 40 females; median age, 35 years) and 50 children (20 males, 30 females; median age, 3.5 years) with chronic diarrhea of unknown origin. All patients underwent a complete work-up to identify the causes of chronic diarrhea. FC was measured by ELISA. Results: In adult patients, FC showed 64% sensitivity and 80% specificity with 70% positive and 74% negative predictive values for organic causes. False-positive results (8 of 40 cases) were associated with the use of aspirin (3 cases) or nonsteroidal antiinflammatory drugs (1 case) and with the presence of concomitant liver cirrhosis (3 cases). False-negative results mainly included patients suffering from celiac disease (5 cases). Patients with IBD (9 cases) were identified with 100% sensitivity and 95% specificity. In pediatric patients, sensitivity was 70%, specificity was 93%, and positive and negative predictive values were 96% and 56%. False-negative results (11 of 35 cases) were associated mainly with celiac disease (6 cases) or intestinal giardiasis (2 cases). Conclusions: FC assay is an accurate marker of IBD in both children and adult patients. In adults, false negatives occur (e.g., in celiac disease) and false-positive results are seen in cirrhosis or users of nonsteroidal antiinflammatory drugs. Diagnostic accuracy is higher in children.

Middle East Journal of Digestive Diseases, 2013

sciencepub.net

Background: Patients with inflammatory bowel disease and irritable bowel syndrome can have overlapping symptoms, yet a different management. Hence, a noninvasive biological marker is needed for the assessment of patients with lower bowel symptoms. Aim: This study aimed at evaluating the the diagnostic value of faecal calprotectin as a potential marker in differentiating patients with inflammatory bowel disease from those with a irritable bowel syndrome. Methods: twenty patients with IBD and twenty patients with IBS were recruited from Ain shams university outpatient clinic in the period between January 2008 to November 2009. In addition, a control group of 10 healthy individuals was included. Faecal calprotectin level using an ELISA technique (Calprest®) was measured in the stool of all groups. Also, atypical p-ANCA and ASCA were performed in the IBD group. Results: At a cut off value of 8.1 mg/L, fecal calprotectin had a negative predictive value (NPV) of 100% to exclude IBS patients with a sensitivity of 100% and a positive predictive value (PPV) to confirm IBD of 95.24% with a specificity of 95%. The diagnostic accuracy of faecal calprotectin in predicting IBD activity was 100% at a cut off value of 25.5 mg/L. Conclusion: fecal calprotectin appears to be a clinically useful noninvasive marker in differentiating IBD from IBS.

Inflammatory Bowel Diseases, 2009

The diagnosis of inflammatory bowel disease (IBD), as well as the evaluation of disease activity, can be challenging. The aim of the study was to evaluate the significance of onestep card tests for fecal calprotectin (FC) and fecal lactoferrin (FL) in patients with IBD. Material and methods: We have examined fecal samples for FC and FL obtained from 29 patients with IBD (15 with ulcerative colitis-UC and 14 with Crohn's disease-CD) and 12 healthy individuals. A qualitative one-step card test was used for each marker. Results: We obtained a sensitivity of 72.4% and 44.8%, for FC and FL, respectively, and positive predictive value (PPV) of 100% for both tests, and negative predictive value (NPV) 60% and 42%, respectively. We found a correlation between the disease activity of CD patients and FC level (p = 0.024, r = 0.583) with Likelihood Ratio (LR) 4.31 (p = 0.038). FC demonstrated also association with platelet count (p = 0.007), serum iron (p = 0.031) and disease duration (p = 0.027), whereas FL showed association with platelet count (p = 0.001), CRP (p = 0.023) and presence of complications (p = 0.017). Conclusion: The one-step card test for fecal markers is useful in the diagnosis of IBD, although FC showed better performance than FL. However, both markers are useful in clinical practice where FC can assess the severity of CD, while FL is elevated in complicated IBD.

The Journal of Pediatric Research

The differentiation of inflammatory bowel diseases (IBD) from other gastrointestinal diseases in pediatric patients is highly important and the definitive diagnosis of IBD is established by endoscopic examination. The use of non-invasive methods (clinical symptoms and laboratory tests) allows for the early and accurate referral of patients from first step health centers to advanced health centers. We aimed to investigate the effectiveness of fecal calprotectin (FC) in the differentiation of IBD from other gastrointestinal diseases in children. Materials and Methods: This retrospective study included patients who had undergone FC testing and colonoscopy. The demographic characteristics, alarm symptoms (AS), and abnormal laboratory findings (ALF) were recorded for each patient. A negative calprotectin result was considered to be less than 50 μg/g, and a second cutoff value for FC was accepted as 150 μg/g. Definitive diagnosis was established by colonoscopy in each patient. Results: The study included 88 consecutive patients (mean age, 10.2±6.1 years; 51.1% female). Of these, 20 (22.7%) patients were diagnosed with IBD. No significant difference was found between IBD and non-IBD patients with regard to the presence of AS except for involuntary weight loss (p<0.001). The prevalence of increased C-reactive protein and hypoalbuminemia was significantly higher in the IBD patients (p=0.002 and p=0.026, respectively). FC>50 μg/g [80.0 vs 39.7%, p=0.044, odds ratio (OR): 6.07, 95% confidence interval (CI) 1.83 to 23.42] and >150 μg/g (60.0 vs 16.2%, p=0.002, OR: 7.78, 95% CI 1.83 to 20.14) was significantly higher in the IBD patients compared to the non-IBD patients. AS combined with ALF and FC>150 μg/g had the highest specificity (95.12%). Conclusion: Although primary care clinicians often use AS and laboratory parameters in the differentiation of IBD from non-IBD diseases, FC was found to have a relatively higher diagnostic value.

Biomedical Reports, 2016

Inflammatory bowel diseases (IBD) are chronic intestinal disorders caused by a number of factors, including external influences, intestinal microbiota and genetics. The two major clinically defined types of IBD are Crohn's disease and ulcerative colitis, each of which is characterized by relapses in the clinical course, thus patients must be under constant observation via regular endoscopies. As endoscopy, which has been used for direct evaluation and diagnosis of IBD, requires uncomfortable and expensive bowel preparation, a non-invasive test was required to reduce the number of patients undergoing unnecessary endoscopy. Calprotectin is a protein occurring in the cytosol of inflammatory cells and is released by the activation of leukocytes. As it is elevated and stable in the faeces of patients with IBD and can be reliably detected in faecal samples of <5 g, it may serve as an inexpensive, non-invasive diagnostic method for IBD. This is explored in the following review. Contents 1. Introduction 2. IBD 3. Calprotectin concentration as a marker for IBD 4. Conclusion