Abstract

BackgroundFaecal calprotectin (FC) testing to detect inflammatory bowel disease (IBD) was recommended for use in UK general practice in 2013. The actual use of FC testing following the national recommendations is unknown.AimTo characterise the use of FC testing for IBD in UK general practice.Design and settingA retrospective cohort study of routine electronic patient records from The Health Improvement Network database from UK general practice.MethodThe study included 6 965 853 adult patients (aged ≥18 years), between 2006 and 2016. FC test uptake, the patients tested, and patient management following testing were characterised.ResultsA total of 17 027 patients had 19 840 FC tests recorded. The mean age of tested patients was 44.2 years. The first FC tests were documented in 2009. FC test use was still increasing in 2016. By 2016, 66.8% (n = 493/738) of practices had started FC testing. About one-fifth (20.7%, n = 1253/6051) of tests were carried out in patients aged ≥60 years. Only 7.8% (n = 473/6051) of the FC test records were preceded by symptoms eligible for FC testing. Only 3.1% (n = 1720/55 477) of patients with eligible symptoms have received FC testing since the national recommendations were published. There was only a small number of patients with symptoms, FC test, and a IBD diagnosis. In total, 71.3% (n = 1416/1987) of patients with a positive and 47.7% (n = 1337/2805) with a negative FC test were referred or further investigated.ConclusionUptake of FC testing in clinical practice has been slow and inconsistent. The indication of non-compliance with national recommendations may suggest that these recommendations lack applicability to the general practice context.

Highlights

  • Faecal calprotectin (FC) is a biomarker for gastrointestinal inflammation

  • 7.8% (n = 473/6051) of the FC test records were preceded by symptoms eligible for FC testing

  • FC testing is recommended by gastroenterological societies across the globe for its usefulness in the diagnosis of inflammatory bowel disease (IBD), a chronic inflammatory condition requiring specialist treatment.[1,2,3,4,5]

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Summary

Introduction

FC testing is recommended by gastroenterological societies across the globe for its usefulness in the diagnosis of inflammatory bowel disease (IBD), a chronic inflammatory condition requiring specialist treatment.[1,2,3,4,5] there is no clear guidance on settings, in which it is considered appropriate. In the UK, FC testing was approved by the National Institute for Health and Care Excellence (NICE) in 2013 for use in general practice in patients when referral to secondary care is being considered and cancer is not suspected (diagnostics guidance: DG11)[6] to reduce the number of unnecessary referrals to colonoscopy. Faecal calprotectin (FC) testing to detect inflammatory bowel disease (IBD) was recommended for use in UK general practice in 2013. The actual use of FC testing following the national recommendations is unknown

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