Abstract
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.
Highlights
The relatively non-specific clinical manifestations of gastrointestinal disease can make it difficult for clinicians to distinguish between functional and organic intestinal disease, especially in patients presenting without rectal bleeding or systemic upset.[1,2] The gold standard for identifying bowel inflammation, colonoscopy and histology, is an expensive and invasive procedure
Faecal calprotectin (FC) is described by the British Society for Gastroenterology inflammatory bowel disease (IBD) guidelines as accurate in detecting colonic inflammation, and a National Institute of Clinical Excellence (NICE) review was completed in October 2013.10,11 The systematic review that has been produced as part of this assessment reported that ‘calprotectin testing will lead to considerable savings to the National Health Service (NHS), as well as the avoidance of an unpleasant invasive procedure in people whose symptoms are due to irritable bowel syndrome (IBS).’[12]
Our findings corroborate existing data showing that FC reliably distinguishes between patients with functional disease and IBD
Summary
The relatively non-specific clinical manifestations of gastrointestinal disease can make it difficult for clinicians to distinguish between functional and organic intestinal disease, especially in patients presenting without rectal bleeding or systemic upset.[1,2] The gold standard for identifying bowel inflammation, colonoscopy and histology, is an expensive and invasive procedure. Faecal calprotectin (FC), a 36.5 kDa calcium-binding cytosolic protein found in neutrophils, is increasingly being used in clinical practice as a surrogate marker for intestinal inflammation. Few studies assess the use of FC in undiagnosed populations; those that do analyze small sample sizes.[3,5,6,7,8,9] FC is described by the British Society for Gastroenterology IBD guidelines as accurate in detecting colonic inflammation, and a NICE review was completed in October 2013.10,11 The systematic review that has been produced as part of this assessment reported that ‘calprotectin testing will lead to considerable savings to the NHS, as well as the avoidance of an unpleasant invasive procedure in people whose symptoms are due to IBS.’[12]. Case notes were interrogated to identify demographics, subsequent investigations and diagnoses.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
