Faecal Calprotectin in the Diagnosis and Monitoring of Inflammatory Bowel Disease.

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Introduction

Faecal calprotectin (FC) is a novel method for measuring gut inflammation which was conceived originally to distinguish between inflammatory bowel disease (IBD) and irritable bowel syndrome.(1) Its use has expanded as a surveillance tool in established IBD. Prudent requesting for this novel test is vital to ensure its sustainability.

Methods

We collected data on the first 150 FC results of 2014. Paediatric and private cases were excluded from the analysis. 108 patients were identified after exclusions were applied, 55 of which had known IBD. Three cut-off points were used in analysing the FC- 200μg/g. Of those not known to have IBD, 6/12 of patients who had calprotectin >200μg/g and 0/15 who had levels 50-199μg/g had evidence of inflammation on colonoscopy.(See Table) Among those with known IBD reviewed in clinic, 51.4%(18/35) of patients in the FC >200μg/g underwent a step-up in therapy compared to 23%(3/13) in the 50-199μg/g group. Twenty-five out of the 54 patients without known IBD had FC <50μg/g, with all such patients declared as not having IBD, only two of which actually undergoing colonoscopy to support this.

Results

Our data corresponds with the literature in that that a FC level below 50μg/g can adequately exclude IBD. When applied as part of the entire approach to the care of those with a suspected or established diagnosis of IBD, FC can be a useful and cost-effective tool. FC levels exceeding 200μg/g when used appropriately can carry high positive predictive value for IBD and steer treatment in established disease.

1. Dabritz J Musci J, Foell D. Diagnostic utility of faecal biomarkers in patients with irritable bowel syndrome. World Journal of Gastroenterology. 2014;20(2):363-75.