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Faecal calprotectin for differentiating between irritable bowel syndrome and inflammatory bowel disease : a useful screen in daily gastroenterology practice

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Banerjee, Ashwini, Srinivas, M., Eyre, Richard, Ellis, Robert, Waugh, Norman, Bardhan, Karna Dev and Basumani, P. (2015) Faecal calprotectin for differentiating between irritable bowel syndrome and inflammatory bowel disease : a useful screen in daily gastroenterology practice. Frontline Gastroenterology, 6 (1). pp. 20-26. doi:10.1136/flgastro-2013-100429

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Official URL: http://dx.doi.org/10.1136/flgastro-2013-100429

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Abstract

Objective To determine the best faecal calprotectin (FCP) cut-off level for differentiating between irritable bowel syndrome (IBS) and organic disease, particularly inflammatory bowel disease (IBD), in patients presenting with chronic diarrhoea.

Design Retrospective analysis of patients who had colonoscopy, histology and FCP completed within 2 months.

Setting District general hospital.

Patients Consecutive new patients with chronic diarrhoea lasting longer than 4 weeks.

Interventions Patients were seen by a single experienced gastroenterologist and listed for colonoscopy with histology. Laboratory investigations included a single faecal specimen for calprotectin assay (lower limit of detection: 8 µg/g), the results used for information only.

Main outcome measures Six FCP cut-off levels (range 8–150 µg/g) were compared against the ‘gold standard’ of histology: inflammation ‘present’ or ‘absent’.

Results Of 119 patients studied, 98 had normal colonoscopy and histology. The sensitivity of FCP to detect IBD at cut-off levels 8, 25 and 50 µg/g was 100% (with corresponding specificity 51%, 51%, 60%). In contrast, the lowest FCP cut-off, 8 µg/g, had 100% sensitivity to detect colonic inflammation, irrespective of cause (with negative predictive value (NPV) 100%). Importantly, 50/119 patients (42%) with FCP <8 µg/g had normal colonoscopy and histology.

Conclusions Our results suggest that using FCP to screen patients newly referred for chronic diarrhoea could exclude all without IBD and, at a lower cut-off, all without colonic inflammation, thus avoiding the need for colonoscopy. Such a major reduction has implications for resource allocation.

Item Type: Journal Article
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Journal or Publication Title: Frontline Gastroenterology
Publisher: BMJ Group
ISSN: 2041-4137
Official Date: January 2015
Dates:
DateEvent
January 2015Published
2 April 2014Available
11 March 2014Accepted
Volume: 6
Number: 1
Page Range: pp. 20-26
DOI: 10.1136/flgastro-2013-100429
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access

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