Diagnostic Value Of Fecal Calprotectin Research Articles

Diagnostic Value of Faecal Calprotectin in Children with Chronic Gastrointestinal Disorders at Yaounde General Hospital

<i>Introduction</i>: Chronic gastrointestinal disorders are common in children. Numerous faecal biomarkers, such as faecal calprotectin, are used in the aetiological diagnosis of these digestive disorders. The study aimed to investigate the diagnostic value of faecal calprotectin in paediatric chronic gastrointestinal disease compared with that obtained in healthy children. <i>Methodology</i>: This was a comparative, analytical cross-sectional study from October 2022 through June 2023 at Yaoundé General Hospital. Participants were children aged between four and eighteen with chronic digestive disorders. Using a pre-established questionnaire, we collected the socio-demographic and clinical characteristics of each participant. The participants' faecal calprotectin was tested at the laboratory of the Yaoundé University Hospital Center by Enzyme-Linked Immunosorbent Assay (ELISA). Associations between variables were investigated by linear regression and calculation of the odds ratio (OR). The significance threshold was 5%. <i>Results</i>: Sixty stool samples were analysed for faecal calprotectin from 30 patients and 30 healthy participants. The mean age of the population was 9.47 (± 3.35) years for patients and 10.67 (± 3.70) years for healthy participants, with a sex ratio of 1.14 for patients and 0.87 for healthy participants. The threshold value for faecal calprotectin was 2.75 µg/g, with a sensitivity of 60%, a specificity of 63%, a positive predictive value of 61.20% and a negative predictive value of 62.06%. There were no significant differences in faecal calprotectin concentrations between children with chronic gastrointestinal disorders (peptic ulcer disease: p=0.10; functional gastrointestinal disorder associated with peptic ulcer disease: p= 0.710; functional gastrointestinal disorder: p= 0.143) and healthy children. <i>Conclusion</i>: The diagnostic value of faecal calprotectin as a biomarker in the diagnosis of chronic gastrointestinal disease was not observed in this study. However, the biological parameters assessed were measured only once, and given that their concentrations may vary over time, we recommend a subsequent longitudinal study.

Diagnostic value of fecal calprotectin in primary care patients with gastrointestinal symptoms: A retrospective Swedish cohort study.

To investigate the diagnostic accuracy of fecal calprotectin (FC) for inflammatory bowel disease (IBD) and organic gastrointestinal disease (OGID) in primary care. To examine the association with demographic factors, symptoms and concomitant medical therapy. A retrospective analysis of data on all semiquantitative FC tests from individuals ≥18 years conducted in primary care in Östergötland County in 2010. A 5-year follow-up with inclusion of new gastrointestinal diagnoses. A total of 1293 eligible patients were included. IBD was found in 8.8% and other OGID in 30.8% of patients with positive FC. Positive FC was associated with diarrhea, age >60 years, duration <3 months, use of nonsteroidal anti-inflammatory drug (NSAID), and proton pump inhibitor (PPI). Predictors of IBD were positive FC, diarrhea, rectal bleeding, and male sex; predictors of OGID positive FC, age >35 years, abnormal clinical findings, and duration <3 months. FC yielded the highest sensitivity and negative predictive value compared with demographic factors, symptoms, and duration. Use of NSAID and PPI showed a marginal increase in the sensitivity, positive predictive value, and decrease in the specificity of FC. Within 5 years, 4.0% had a new gastrointestinal diagnosis among patients with positive FC (0.6% IBD). FC reliably rules out IBD and contradicts the presence of other OGID in primary care patients. Positive FC test together with other predictors, such as diarrhea, rectal bleeding, short duration, or age >35 years, should encourage a prioritized investigation. Use of NSAID, PPI, and ASA may affect the diagnostic accuracy of FC for IBD and OGID.

The usefulness of fecal hemoglobin and calprotectin tests in diagnosing significant bowel diseases: a prospective study

Objectives Although colonoscopy remains the gold standard for determining bowel diseases, it’s invasive and expensive. New non-invasive diagnostic methods are urgently needed as an initial screening modality. We aimed to investigate the value of fecal calprotectin (FC) and fecal immunochemical test (FIT) in differentiation of significant and non- significant bowel diseases. Methods In this prospective study, consecutive individuals were included if they underwent colonoscopy for symptoms of lower gastrointestinal (GI) tract, positive fecal occult blood test, surveillance for IBD or colorectal cancer (CRC) screening. Diagnostic value of FC and FIT in discriminating significant bowel diseases (advanced neoplasia, active inflammatory bowel diseases or bowel inflammation due to other causes) and non-significant bowel diseases (normal, asymptomatic diverticulum, non-adenomatous polyp, or non-advanced neoplasia) were evaluated. Results Among 201 individuals included, 107 patients had significant bowel diseases. FC and FIT had an area under the curve (AUC) of 0.722 (95% confidence interval [CI] 0.653–0.792) and 0.797 (95%CI 0.734–0.860), respectively, for determining significant bowel diseases. Combination of FC and FIT predicted significant bowel diseases with an AUC, sensitivity, specificity, and accuracy of 0.832 (95% CI 0.775–0.890), 77.6%, 74.5%, and 76.1%, respectively. Moreover, combination of FC and FIT was more sensitive among patients with lower GI symptoms than asymptomatic individuals (80.8% vs. 74.1%) to identify significant bowel diseases. Conclusions A single measurement of FC or FIT is not sufficiently accurate to identify patients with significant bowel disease. However, combination of FC and FIT can help increase the sensitivity, especially in patients with lower GI symptoms.

Diagnostic approach to chronic bowel diseases in children

Diagnosing inflammatory bowel diseases in children and differentiating them from functional disorders is complicated based on clinical assessment, laboratory data, and radiological, endoscopic, and histological signs. Therefore, in paediatrics, substantial attention has been given to standard invasive evaluation methods. Recently, research efforts have been directed towards using faecal calprotectin as a sensitive non-invasive stool test.&#x0D; The aim of the research was to study the diagnostic value of faecal calprotectin in pediatric chronic inflammatory bowel diseases. The paper discusses faecal calprotectin's diagnostic and monitoring role in 35 children aged 3 to 17 years with ulcerative colitis, non-specific non-ulcerative colitis, and irritable bowel syndrome. The concentration of the faecal calprotectin level was examined by ELISA using monoclonal antibodies.&#x0D; Results. The study shows that in patients with non-specific ulcerative and non-ulcerative colitis, the faecal calprotectin level exceeds the normal ranges 2-5 times, corresponding to clinical and morphological manifestations of the diseases and the level of inflammatory markers. However, this biological marker does not exceed the average values in children with irritable bowel syndrome.&#x0D; Conclusions. The faecal calprotectin test allows us to differentiate organic and functional intestinal diseases, monitor chronic inflammatory bowel disease activity dynamics, and estimate treatment effectiveness. Applying the faecal calprotectin test within the framework of primary medical care can decrease the number of referrals for invasive endoscopic, laboratory, and radiologic examinations in pediatric patients with inflammatory bowel diseases

Значення дослідження фекального кальпротектину в діагностиці хронічних запальних захворювань кишечника у дітей

Актуальність. Запальні захворювання кишечника є однією з найбільш складних проблем в дитячій гастроентерології, що мають не тільки медичне, але й соціальне значення. Останнім часом велика увага приділяється неінвазивним методам діагностики, серед яких при хронічних запальних захворюваннях кишечника розглядають фекальні маркери запалення. Метою роботи було вивчення діагностичної цінності фекального кальпротектину при хронічних захворюваннях кишечника у дітей. Матеріали та методи. Обстежено 19 пацієнтів від 3 до 17 років з хронічними запальними захворюваннями кишечника в активній фазі (виразковим колітом і хронічним неспецифічним невиразковим колітом). Групу порівняння становили 12 дітей із синдромом подразненого кишечника. Крім стандартних методів обстеження, у хворих вивчали вміст кальпротектину в зразках калу з використанням моноклональних антитіл. Результати. Згідно з даними нашого дослідження, у пацієнтів з хронічними запальними захворюваннями кишечника середній рівень кальпротектину в калі перевищував нормальні показники в 3 рази, причому в усіх обстежених хворих в активній фазі хронічних запальних захворювань кишечника кальпротектин калу був підвищений. Середні значення фекального кальпротектину були вірогідно вище у хворих з виразковим колітом порівняно з пацієнтами з неспецифічним невиразковим колітом. При функціональному захворюванні — синдромі подразненого кишечника — рівні фекального кальпротектину не виходили за межі нормальних значень у жодного з пацієнтів. Висновки. Вивчення фекального кальпротектину при хронічних запальних захворюваннях кишечника у дітей має високу діагностичну цінність як скринінг для виключення органічної природи захворювання и визначення показань для проведення інструментальних методів діагностики. Впровадження неінвазивної методики вивчення кальпротектину в зразках калу дозволить моніторувати перебіг хронічних запальних захворювань кишечника у дітей в динаміці, оцінювати результати терапії, а також скоротити кількість інвазивних методів обстеження.

Study of biochemical markers in newborns with necrotizing enterocolitis

Aim. To study the level of biochemical markers to optimize the diagnosis and prognosis of necrotizing enterocolitis in newborns. Methods. 110 newborns with necrotizing enterocolitis were observed in the intensive care unit at the age of 1 to 28 days. According to the stages of necrotizing enterocolitis, all examined newborns were divided into three groups. Group 1 consisted of 49 newborns (40.5%) with necrotizing enterocolitis stage I, group 2 included 48 newborns (39.7%) with necrotizing enterocolitis stage II and group 3 included 13 newborns (10.7%) with necrotizing enterocolitis stage III. In 40 newborns with necrotizing enterocolitis, matrix metalloproteinase-2, -9, -17, cathelicidin, transferrin in the blood and fecal calprotectin in the feces were measured by ELISA. Results. Comparative analysis demonstrated that matrix metalloproteinase-2 was increased in newborns from group 1 by 6.9 times, in group 2 - by 8.3 times and in group 3 - by 10.7 times. Similarly, the level of metalloproteinase-9 was increased in group 1 by 3 times, in group 2 by 3.4 times, and in group 3 by 4.5 times compared to the newborns from the control group. The concentration of metalloproteinase-17 in newborns from groups 1 and 2 was almost the same and increased on average by 2.5 times, and by 3.6 times in group 3 compared to the control. In examined newborns, the highest level of cathelicidin and lowest level of transferrin were observed in necrotizing enterocolitis stage III, which indicates the more severe course of the disease and may be a predictor of changes in treatment tactics. So, taking into account the diagnostic value of fecal calprotectin (75%), it can be used as a noninvasive marker of inflammation in the intestine. Conclusion. The established changes in the level of biochemical markers (metalloproteinases, cathelicidin and transferrin in the blood and fecal calprotectin in feces) have diagnostic and prognostic value in the diagnosis, prediction of outcomes and optimization of treatment tactics of necrotizing enterocolitis in neonatal practice.

Diagnostic Value of Fecal Calprotectin in Response to Mother’s Diet in Breast-Fed Infants with Cow’s Milk Allergy Colitis

Background: Food allergy is an abnormal immunologic reaction to food proteins. During infancy, allergic colitis presents with bloody stool of a healthy child. calprotectin is released into the intestinal lumen by macrophages and neutrophils and is a reliable and non-invasive biomarker for evaluating inflammation of the digestive system. Objectives: This study evaluated the changes of fecal calprotectin after modification of mother’s diet, on breastfed infants with food allergy. Methods: This study was conducted on 29 infants less than one year old with allergic colitis, referred to the Besat hospital of Sanandaj (Iran) from 2013 to 2014. All infants were breast-fed. The fecal calprotectin levels were measured on admission; two and six weeks after starting hypo-allergenic diet for mothers and its levels were correlated with clinical findings. Results: With the onset of maternal hypoallergenic diet, clinical symptoms showed a statistically significant reduction (P < 0.05). The fecal calprotectin levels decreased during the study. Despite the declining trend of the fecal calprotectin levels, there was no statistical correlation between clinical and laboratory findings (P = 0.741 and P = 0.284). Conclusions: This study showed that changes on fecal calprotectin levels are not a good indicator for assessment of clinical improvement in food allergy. There was no statistically significant difference between the fecal calprotectin levels on admission, two weeks and six weeks after the intervention.

A New Immunofluorescence Assay for Fecal Calprotectin Distinguishes Inflammatory Bowel Disease from Functional Bowel Disease

Aims: To investigate the diagnostic value of fecal calprotectin (FC) determined by a new immunofluorescence assay-fluorescence enzyme immunoassay (FEIA) in patient with inflammatory bowel disease (IBD) or functional bowel disease, compared with the typical ELISA kit. Methods: FC was determined simultaneously by FEIA and an ELISA kit in 26 patients with functional bowel disease and 77 patients with IBD. We compared the difference of FC levels between patients with IBD and patients with functional bowel disease. Receiver operating characteristics curve (ROC) was constructed to obtain the optimal cut-off value of FC for distinguishing IBD from functional bowel disease and the corresponding sensitivity and specificity. Results: The median FC levels of patients with IBD in clinical active stage or clinical remission stage was significantly higher than that of patients with functional bowel disease. The median FC levels of patients with IBD in clinical active stage, IBD in clinical remission stage and functional bowel disease were as follow: 699.91 (346.14 ~ 1647.54) μg/g; 407.36 (121.81 ~ 878.48) μg/g; 39.04 (12.09 ~ 81.04) μg/g when FC was measured by FEIA. The median FC levels were 716.99 (240.42 ~ 1232.53) μg/g; 338.46 (53.08 ~ 692.82) μg/g; 41.44 (11.77 ~ 73.19) μg/g among such above three groups of patients respectively, when FC was measured by ELISA kit. The diagnostic value of IBD with FC determined by FEIA (optimal cut-off = 131.79 μg/g) and ELISA kit (optimal cut-off = 121.85 μg/g) presented an area under the curve of 0.881 and 0.873, respectively. Conclusions: FC determined by FEIA was an accurate surrogate marker to distinguish IBD from functional bowel disease.

Diagnostic Value of Fecal Calprotectin and Serum MMP-9 in Diagnosing Disease Activity of Ulcerative Colitis

Background and Study Aim: Ulcerative colitis (UC) is a chronic, idiopathic inflammatory bowel disease characterized by remission of disease activity. Searching for laboratory markers which are simple, sensitive, specific and noninvasive is fundamental to assess the extent of inflammation, activity of the disease, evolution and prognosis which can be used to assess response to treatment and the possibility of relapse. Our aim of the work was to investigate the diagnostic role of fecal calprotectin and serum MMP-9 in determining the activity of ulcerative colitis. Patients and Methods: 71 patients were included in the study and fecal calprotectin, serum MMP-9, ESR and CRP were measured in these patients to determine the disease activity of ulcerative colitis. Results: Fecal calprotectin concentration in the patients with active UC was significantly higher than that in inactive disease and in controls (387.21 ± 44.07 μg/g vs 103.62 ± 119.67 μg/g, 12.44 ± 3.65 μg/g, p = 0.000). Serum MMP-9 was found to be higher in patients with active UC than in patients with inactive disease (11.02 ± 5.29 vs 4.01 ± 1.72 ng/ml, p = 0.000). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. Also, strong positive correlation was found between fecal calprotectin and serum MMP-9 and the severity of the disease. The area under the curve of the receiver operating characteristics (AUCROC) was 0.949 and 0.941 for fecal calprotectin and serum MMP-9 respectively. Conclusion: Fecal calprotectin and serum MMP-9 can be used to differentiate between active and inactive forms of UC.

Diagnostic Value of Fecal Calprotectin in Preterm Infants with Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is the most commonly acquired gastrointestinal emergency among neonates. However, the present diagnosis methods of NEC are non-specific and do not provide sufficient insight into the early discrimination. Fecal calprotectin (FC) is an intestinal-specific biomarker and has been used to differentiate different intestinal diseases. The aim of this study is to evaluate the value of FC as an early indicator for the identification of NEC. A total of 40 preterm infants were recruited, including 17 cases with NEC and 23 normal preterm infants. At enrollment, the clinical features, radiological finding, serological test, and other test results of subjects were recorded. FC concentration assays were performed by enzyme-linked immunosorbent assay (ELISA). The classification of the NEC was confirmed with the modified Bell staging criteria. The median FC levels in the NEC group were significantly higher than those in the non-NEC group (858 (347.5, 1417.5) vs. 179 (125,265) μg/g, p < 0.001). There was statistical difference in stage I, II, and III of NEC (χ2 = 6.672, p = 0.036), the median FC levels were 457 (309, 875), 932 (532, 1712), and 3108 (1378, 4276) μg/g, respectively. FC levels were correlated negatively to platelet counts (r = -0.491, p = 0.001), and positively to CRP (0.357, p = 0.024). The ROC curve defined a cutoff of 281 μg/g for NEC in preterm infants (Z = 11.737, p < 0.001), the area under the curve (AUC) (95% confidence interval) was 0.931 (0.804, 0.987), and the sensitivity and specificity were 88.24% (63.6%, 98.5%), 82.61% (61.2%, 95.0%), respectively. FC concentration is a useful, safe, and noninvasive test. It increases in preterm infants with NEC and has the potential to diagnose NEC early and to remind us of the severity of NEC in preterm infants.

Diagnostic Value of Fecal Calprotectin (S100 A8/A9) Test in Children with Chronic Abdominal Pain.

Objectives. The aim of the study was to establish whether fecal calprotectin concentration (FCC) may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included 163 patients (median age 13 years), who were assigned to four study groups: group 0 (control), 22 healthy children; group 1, 33 children with functional gastrointestinal disorders; group 2, 71 children with inflammatory gastrointestinal disorders other than IBD; group 3, 37 children with IBD. FCC was measured using ELISA assay. Results. In group 0 and group 1 FCCs were below 100 μg/g. Low FCCs were found in 91% of patients in group 2. In patients with IBD FCCs were markedly elevated with median value of 1191.5 μg/g. However, in children with inflammatory gastrointestinal disorders other than IBD and in children with IBD mean FCCs were significantly higher compared with the control group. Significant differences in FCCs were also found between group 1 and group 2, between group 1 and group 3, and between group 2 and group 3. Conclusion. FCC is the best parameter allowing for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. High FCC is associated with a high probability of IBD and/or other inflammatory gastrointestinal disorders, and it allows excluding functional gastrointestinal disorders.

Fecal calprotectin: can be used to distinguish between bacterial and viral gastroenteritis in children?

ObjectiveFecal calprotectin is used as a good indicator of intestinal mucosal inflammation. The aim of this study is to evaluate the diagnostic value of fecal calprotectin (f-CP) for the etiology of acute gastroenteritis in children. Materials and methodsAll patients presenting with acute diarrhea (<18 years) who had 3 or more soft or watery stools per day were enrolled in this study. Stool microscopic examination and cultures for bacteria and parasites were performed. Polymerase chain reaction test was also applied to stool samples for viruses (Rotavirus, Adenovirus, Norwalk, and Astrovirus). The level of f-CP was carried out by using enzyme-linked immunosorbent assay test. ResultsEighty-four patients with diarrhea were enrolled. The f-CP level was higher in patients with microscopic examination positive (n = 17) (median with interquartile range, 1610.0 [908.8-2100] mg/L) than in patients with microscopic examination negative (n = 67) (123.8 [25.0-406.3] mg/L) (P < .001). Concentrations of f-CP in patients with stool culture positive (1870.0 [822.5-2100] mg/L) were significantly elevated compared with the concentrations of the patient with virus detected in stool (95.0 [21.3-240.9] mg/L) (P < .001). In the diagnosis for bacterial acute gastroenteritis, the area under the receiver operating characteristic curve for f-CP was 0.867 (95% confidence interval, 0.763-0.971), sensitivity was 88.9%, and specificity was 76.0% if the threshold was taken as 710 mg/L. ConclusionWe conclude that f-CP, which is useful, valuable, noninvasive, easily and rapidly measured laboratory test along with simple microscopic examination of stool, can be used as an indicator of intestinal inflammation and to distinguish the bacterial gastroenteritis from the viral gastroenteritis.

Fecal calprotectin in patients with suspected small bowel disease – a selection tool for small bowel capsule endoscopy?

Objective. Fecal calprotectin (FC) has been proposed as a selection tool for gastrointestinal examinations, but the use of FC in the diagnosis of small bowel disease in particular is less studied. The aim of this study was to assess if FC could be used to predict findings on small bowel capsule endoscopy (SBCE). Material and methods. We retrospectively collected FC values, SBCE findings and clinical data in 161 patients with suspected small bowel disease referred for SBCE. Findings on SBCE were correlated with FC levels and the diagnostic value of FC was assessed. Results. Of the 161 patients, 37.3% had a positive FC and 29.8% had a finding on SBCE. Overall there was a significant difference in FC values between patients with any finding on SBCE and patients with a normal SBCE, but patients with ulcers/erosions was the only subgroup of patients with FC values significantly higher than patients with a normal SBCE. The proportion of patients with findings on SBCE increased with increasing FC value. A positive FC (≥50 mg/kg) had a sensitivity, specificity, positive predictive value and negative predictive value of 54.2%, 69.9%, 43.3% and 78.2%, respectively, for predicting findings on SBCE. Conclusions. FC alone cannot be used as a selection tool for SBCE in patients with suspected small bowel disease in a specialist setting. However, a high FC value implies a higher probability of finding significant pathology on SBCE, and thus strengthens the indication for performing the examination.

Diagnostic yield of endoscopy in patients with abdominal complaints: incremental value of faecal calprotectin on guidelines of appropriateness

BackgroundEuropean Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria have been developed to increase diagnostic yield, but their predictive value is limited. We investigated the incremental diagnostic value of faecal calprotectin to EPAGE criteria.MethodsIn a post-hoc analysis of a prospective study, EPAGE criteria were applied to 298 of 575 (51.8%) patients who had undergone esophagogastroduodenoscopy (EGD), colonoscopy or both for abdominal complaints at the Division of Gastroenterology & Hepatology at the University Hospital Basel in Switzerland. Faecal calprotectin was measured in stool samples collected within 24 hours before the investigation using an enzyme-linked immunosorbent assay. Final endoscopic diagnoses were blinded to calprotectin values.ResultsOf 149 EGDs and 224 colonoscopies, 17.6% and 14.7% respectively were judged inappropriate by EPAGE criteria. Appropriate or uncertain indications revealed more endoscopic findings in both EGD (46.3% vs. 23.1%, P = 0.049) and colonoscopy (23.6% vs. 6.1%, P = 0.041) than inappropriate indications. Median calprotectin levels were higher (81.5 μg/g, interquartile range 26-175, vs. 10 μg/g, IQR 10–22, P < 0.001) and testing was more often positive (>50 μg/g) in patients with endoscopic findings, both in EGD (58.2% vs. 33.0%, P = 0.005) and in colonoscopy (57.3% vs. 7.4%, P < 0.001). The use of faecal calprotectin in addition to EPAGE criteria improved the risk reclassification of patients by endoscopic findings. The calculated net reclassification index was 37.8% (P = 0.002) for EGD and 110.9% (P <0.001) for colonoscopy, thus improving diagnostic yield to 56.8% and 70.2%, respectively.ConclusionsThe use of faecal calprotectin in addition to EPAGE criteria improved diagnostic yield in patients with abdominal complaints.

Diagnostic Value of Fecal Calprotectin as a Screening Biomarker for Gastrointestinal Malignancies

Calprotectin in feces seems to be a more sensitive marker for gastrointestinal (GI) cancers than fecal occult blood, but its specificity may be too low for screening average risk populations. This study aims at evaluating the diagnostic value of fecal calprotectin as a screening biomarker for GI malignancies. In a case-control study, 100 patients with GI malignancies (50 patients with colorectal cancer and 50 patients with gastric cancer) and 50 controls were recruited in Tabriz Imam Reza and Sina hospitals during a 24-month period. One to two weeks after the last endoscopy/colonoscopy, fecal specimens were collected by the patients and examined by ELISA method for quantitative measurement of calprotectin content. The results were compared between the three groups. The mean fecal calprotectin level was 109.1 ± 105.3 (2.3-454.3, median:74), 241.1 ± 205.2 (3.4-610.0, median:19.3) and 45.9 ± 55.1 μg/g (1.3-257.1, median:19.3) in gastric cancer, colorectal cancer and control group, respectively, the differences being significant (p<0.001) and remaining after adjustment for age. The optimal cut-off point for fecal calprotectin was ≥ 75.8 μg/g for distinguishing colorectal cancer from normal cases (sensitivity and specificity of 80% and 84%, respectively). This value was ≥ 41.9 μg/g for distinguishing gastric cancer from normal cases (sensitivity and specificity of 62%). Our results revealed that fecal calprotectin might be a useful and non-invasive biomarker for distinguishing colorectal cancer from non-malignant GI conditions. However, due to low sensitivity and specificity, this biomarker may not help physicians distinguishing gastric cancer cases from healthy subjects.

Challenges in diagnostic accuracy studies in primary care: the fecal calprotectin example

BackgroundLow disease prevalence and lack of uniform reference standards in primary care induce methodological challenges for investigating the diagnostic accuracy of a test. We present a study design that copes with these methodological challenges and discuss the methodological implications of our choices, using a quality assessment tool for diagnostic accuracy studies (QUADAS-2).DesignThe study investigates the diagnostic value of fecal calprotectin for detecting inflammatory bowel disease in children presenting with chronic gastrointestinal symptoms in primary care. It is a prospective cohort study including two cohorts of children: one cohort will be recruited in primary care and the other in secondary/tertiary care. Test results of fecal calprotectin will be compared to one of the two reference standards for inflammatory bowel disease: endoscopy with histopathological examination of mucosal biopsies or assessment of clinical symptoms at 1-year follow-up.DiscussionAccording to QUADAS-2 the use of two reference standards and the recruitment of patients in two populations may cause differential verification bias and spectrum bias, respectively. The clinical relevance of this potential bias and methods to adjust for this are presented. This study illustrates the importance of awareness of the different kinds of bias that result from choices in the design phase of a diagnostic study in a low prevalence setting. This approach is exemplary for other diagnostic research in primary care.

PTU-053 Usefulness of Fecal Calprotectin in Clinical Practice in a District General Hospital

IntroductionCalprotectin is a calcium and zinc binding protein, mainly contained in neutrophils. If present in stools it is a marker of bowel inflammation. We evaluated the diagnostic value of faecal...

Usefulness of Fecal Calprotectin in Clinical Practice in a District General Hospital

Calprotectin is a calcium and zinc binding protein, mainly contained in neutrophils. If present in stools it is a marker of bowel inflammation. We evaluated the diagnostic value of fecal calprotectin (FC) as a non-invasive marker of bowel inflammation in routine out-patient gastroenterology clinic. A retrospective study of patients who had FC testing presenting with a multitude of gastrointestinal symptoms in a district general hospital over a 12 month period. The clinical, FC results and the endoscopic findings were recorded. FC level more than 50 μg/gm was considered positive. FC was requested for 72 patients. 44 were female (mean age 44 years) and 28 were male (mean age 47 years). FC was requested for various symptoms including chronic diarrhoea, abdominal pain, abdominal distension and per rectal bleeding. Patients were divided into 3 groups based on clinical practice of gastroenterologist. In the first group only FC was requested initially as a screening test to assess bowel inflammation. 31 patients fell in this group, 21 of 31 had negative FC and no further investigations were done, while 10 of 31 had positive FC (mean 150.3 μg/gm). Out of these 5 had no further investigations as symptoms settled on subsequent clinic visit and 5 went on to have further investigations (Colonoscopy +/− Capsule endoscopy) which were all normal. In the second group patient's had both FC and colonoscopy requested on initial out-patient review. There were 23 patients in this group. 13 of 23 had normal FC and colonoscopy and no further investigations were done. 2 of 23 had abnormal FC (mean 271.5 μg/gm) and colonoscopy. Both were diagnosed with IBD. 8 of 23 had raised FC (mean 171.25 μg/gm) but a normal colonoscopy. 5 of 8 had no further investigations done while 3 had small bowel investigations which were normal. 1 patient of these 3 was treated for presumed small bowel Crohn's due to raised FC despite normal capsule endoscopy with good effect. In the third group colonoscopy was the initial investigation of choice and was found to be normal but FC was done later in view of persistent symptoms to look for small bowel inflammation. 18 patients fell in this group. 12 of 18 had normal FC and had no further investigations. 6 of 18 had raised FC (mean 114.33 μg/gm). 3 patients with raised FC had small bowel investigation done and all were normal. In conclusion FC was beneficial when negative. It provided reassurance to the clinicians and helped avoid invasive investigations. However when FC was positive clinical judgment and patient symptoms dictated the need for further investigations. None of the patients diagnosed with IBD had a negative FC.

Fecal Calprotectin as a Correlative Marker in Clinical Severity of Infectious Diarrhea and Usefulness in Evaluating Bacterial or Viral Pathogens in Children

Calprotectin is a marker associated with intestinal inflammation. The aim of this study is to explore the diagnostic value of fecal calprotectin in predicting bacterial/viral diarrhea and the application of fecal calprotectin in the clinical course of infectious diarrhea. Patients ages from 3 months to 10 years with infectious diarrhea were enrolled, and from each patient, 2 to 3 stool samples were collected. Fecal calprotectin levels were determined by enzyme-linked immunosorbent assay and compared by pathogen and disease activity. A univariate linear regression was used to determine the correlation between fecal calprotectin and the clinical parameters, and generalized estimating equations (GEEs) were used for the time course analyses. The data include 451 evaluations for 153 individuals across 3 different time points. The fecal calprotectin level was higher in patients with Salmonella infection (median with range 765 [252-1246] μg/g) or Campylobacter infection (689 [307-1046] μg/g) compared with patients with rotavirus infection (89 [11-426] μg/g), norovirus infection (93 [25-405] μg/g), or adenovirus infection (95 [65-224] μg/g). Fecal calprotectin concentrations were elevated in patients with severe (843 [284-1246] μg/g) or moderate (402 [71-995] μg/g) disease activity compared with those with mild (87 [11-438] μg/g) disease activity (P < 0.05). GEE analysis suggests that fecal calprotectin is correlated with clinical severity (e.g., Vesikari score) and may provide information for disease management. Fecal calprotectin levels increased during bacterial infection and as disease severity increased, and its levels on the initial evaluation and follow-up visit are correlated with clinical severity. Fecal calprotectin may be a useful marker for application in children during infectious diarrhea.

Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study

BackgroundThe evaluation of patients with abdominal discomfort is challenging and patient selection for endoscopy based on symptoms is not reliable. We evaluated the diagnostic value of fecal calprotectin in patients with abdominal discomfort.MethodsIn an observational study, 575 consecutive patients with abdominal discomfort referred for endoscopy to the Department of Gastroenterology & Hepatology at the University Hospital Basel in Switzerland, were enrolled in the study. Calprotectin was measured in stool samples collected within 24 hours before the investigation using an enzyme-linked immunosorbent assay. The presence of a clinically significant finding in the gastrointestinal tract was the primary endpoint of the study. Final diagnoses were adjudicated blinded to calprotectin values.ResultsMedian calprotectin levels were higher in patients with significant findings (N = 212, median 97 μg/g, IQR 43-185) than in patients without (N = 326, 10 μg/g, IQR 10-23, P < 0.001). The area under the receiver operating characteristics curve (AUC) to identify a significant finding was 0.877 (95% CI, 0.85-0.90). Using 50 μg/g as cut off yielded a sensitivity of 73% and a specificity of 93% with good positive and negative likelihood ratios (10.8 and 0.29, respectively). Fecal calprotectin was useful as a diagnostic parameter both for findings in the upper intestinal tract (AUC 0.730, 0.66-0.79) and for the colon (AUC 0.912, 0.88-0.94) with higher diagnostic precision for the latter (P < 0.001). In patients > 50 years, the diagnostic precision remained unchanged (AUC 0.889 vs. 0.832, P = 0.165).ConclusionIn patients with abdominal discomfort, fecal calprotectin is a useful non-invasive marker to identify clinically significant findings of the gastrointestinal tract, irrespective of age.