Faecal calprotectin delivers on convenience, cost reduction and clinical decision‐making in inflammatory bowel disease: a real‐world cohort study

Motaganahalli, Satwik; Beswick, Lauren; Con, Danny; Langenberg, Daniel R. van

doi:10.1111/imj.14027

Cited by 12 publications

(16 citation statements)

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“…In two studies, 12 out of 14 or 21 out of 34 positive FC values (≥ 250 μg/g) resulted in colonoscopies [26, 27]. In addition, Motaganahalli et al [11] showed that patients with positive FC (≥ 250 μg/mL) underwent colonoscopy earlier than patients with negative FC (< 100 μg/mL). However, none of these studies separated the CD from the UC cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Local laboratory cut-off values were applied, with a result deemed ‘negative or normal’ if FC <50 mg/Kg, ‘positive’ if FC ≥50 mg/Kg and ‘definitely or highly positive’ if FC ≥250 mg/Kg. For this study, the cut-off value for FC was determined at 250 mg/Kg, as in other similar studies [11, 24–28]. FC > 250 mg/Kg was considered a positive value.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, FC is closely correlated with faecal excretion of 111 indium-labelled leucocytes [10]. FC is easy to assess by enzyme-linked-immunosorbent assay (ELISA) and represents a non-invasive, cheap and sensitive marker of intestinal inflammation [9, 11]. Besides, FC is stable in stools for up to 7 days at room temperature and resistant to degradation [12].…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have shown that FC is significantly higher in patients with active IBD than in patients with remission [13–15]. In addition, FC correlates with the clinical, endoscopic and histological activity in IBD patients [11, 16, 17]. FC also correlates well with colonic intestinal inflammation in both CD and UC, but is less reliable in detecting small bowel inflammation in CD [18].…”

Section: Introductionmentioning

confidence: 99%

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Impact of faecal calprotectin measurement on clinical decision-making in patients with Crohn’s disease and ulcerative colitis

Bathe¹,

Mavropoulou²,

Mechie³

et al. 2019

PLoS ONE

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BackgroundFaecal calprotectin (FC) seems to be the best available biomarker for the detection of intestinal inflammation in patients with inflammatory bowel disease (IBD). The aim of this study is to clarify whether the measurement of FC has changed the number of ultrasound and endoscopic procedures, drug modifications, as well as FC re-measurements in IBD patients.MethodsThis retrospective study included 242 IBD patients with available FC values (case cohort) and 46 patients without an available FC value (control cohort). Clinical consequences such as carrying out abdominal ultrasound, endoscopy, drug modification or FC re-measurement at the next ambulatory presentation or during in-patient stay were collected. Statistical analysis was performed to determine the association between clinical decision-making and patient’s characteristics, especially FC value.ResultsOverall, 192 (67%) clinical consequences were noted in both cohorts. In the case cohort 174 (91%) implications were noted compared to 18 (9%) in the control cohort (P < 0.001). In the case cohort, significantly more clinical consequences were detected in patients with Crohn’s disease (CD) as well as in ulcerative colitis (UC) patients with a FC value > 250 mg/Kg than in patients with a value of ≤ 250 mg/Kg. In CD patients with high FC values significantly increased numbers of abdominal ultrasounds, endoscopies and FC re-measurements were noted. In UC patients with high FC values significantly increased numbers of abdominal ultrasounds, drug modifications and FC re-measurements were noted.ConclusionMeasurement of FC may alter physician’s clinical decision-making in IBD patients beside other clinical and diagnostic parameters. Further prospective and survey studies are warranted to evaluate the influence of FC measurement in the daily clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of faecal calprotectin measurement on clinical decision-making in patients with Crohn’s disease and ulcerative colitis

Bathe¹,

Mavropoulou²,

Mechie³

et al. 2019

PLoS ONE

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“…The state-of-the-art treatment goal for UC has shifted from clinical remission with symptom control to endoscopic remission using the treat-to-target strategy ( Jackson & De Cruz, 2019 ; Rubin et al, 2019 ; Wei et al, 2017 ). Fecal calprotectin (FC) is a non-invasive fecal marker commonly used in Western countries to determine mucosal healing ( Freeman et al, 2019 ; Motaganahalli et al, 2019 ); however, FC is expensive compared with the immune fecal occult blood test (iFOBT) and is not reimbursed for clinical use in Taiwan. By contrast, colonoscopy remains the gold standard for the assessment of colonic mucosal status, enables screening for colitis-associated malignancies ( Wei et al, 2017 ; Yen et al, 2017 ), and costs less in Asia than in Western countries ( Chang et al., 2020 ; Yen & Hsu, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Predictive values of stool-based tests for mucosal healing among Taiwanese patients with ulcerative colitis: a retrospective cohort analysis

Yen

Chen

Chang

et al. 2020

PeerJ

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Background/Purpose Over the past two decades, ulcerative colitis (UC) has emerged in the Asia Pacific area, and its treatment goal has shifted from symptom relief to endoscopic remission. Endoscopy is the gold standard for the assessment of mucosal healing; however, it is an invasive method. Fecal calprotectin (FC) is a non-invasive stool-based inflammatory marker which has been used to monitor mucosal healing status, but it is expensive. By contrast, the immune fecal occult blood test (iFOBT) is a widely utilized stool-based screening tool for colorectal cancer. In this study, we compared the predictive values of iFOBT and FC for mucosal healing in Taiwanese patients with UC. Methods A total of 50 patients with UC identified via the electronic clinical database of Changhua Christian Hospital, Taiwan, were retrospectively enrolled from January 2018 to July 2019. Results of iFOBT, FC level, and blood tests as well as Mayo scores were reviewed and analyzed. Colonic mucosa was evaluated using the endoscopic Mayo subscore. Results The average age of the patients was 46 years, and 62% of the patients were men. Disease distribution was as follows: E1 (26%), E2 (40%), and E3 (34%). Complete mucosal healing (Mayo score = 0) was observed in 30% of patients. Endoscopic mucosal healing with a Mayo score of 0 or 1 was observed in 62% of the patients. Results of FC and iFOBT were compared among patients with and without mucosal healing. Predictive cutoff values were analyzed using receiver operating characteristics curves. iFOBT and FC had similar area under the curve for both complete mucosal healing (0.813 vs. 0.769, respectively, p = 0.5581) and endoscopic mucosal healing (0.906 vs. 0.812, respectively, p = 0.1207). Conclusion In daily clinical practice, FC and iFOBT do not differ in terms of predictive values for mucosal healing among Taiwanese patients with UC.

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International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases

et al. 2021

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Background: Fecal calprotectin (FC) is a non-invasive marker of gut inflammation which is frequently used to guide therapeutic decisions in patients with inflammatory bowel diseases (IBD). Each step of FC measurement can influence the results, leading to misinterpretations and potentially impacting the management of IBD patients. To date, there is high heterogeneity between FC measurements and no current method is universally accepted as a standard.Aims: Our aim was to provide clear position statementsabout the pre-analytical and the analytical phases of FC measurement to homogenize FC levels and to minimize variability and risk of misinterpretation through aninternational consensus.Materials & Methods: Fourteen physicians with expertise in the field of IBD and FC from 11 countries attended a virtual international consensus meeting on July 17th, 2020. A systematic literature was conducted and the literature evidence was shared and discussedamong the participants. Statements were formulated, discussed, and voted. Statements were considered approved if all participants agreed.Results: Nine statements were formulated and approved. Based on the available evidence, quantitative tests should be preferred for measuring FC. Furthermore, FC measurement, if possible, should always be performed with the same method and factors influencing FC levels should be taken into account when interpreting the results.Discussion: FC has an increasingly important role in the management of patients with IBD. However, large multicenter studies should be conducted to define the reproducibility and to confirm the diagnostic accuracy of the available FC tests.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Faecal calprotectin delivers on convenience, cost reduction and clinical decision‐making in inflammatory bowel disease: a real‐world cohort study

Abstract: Introduction of FC into routine IBD care aided changes in clinical management in a similar proportion, yet at potentially half the total cost, compared to a historical colonoscopy-only cohort at the same centre. This article is protected by copyright. All rights reserved.

Cited by 12 publications

References 27 publications

Impact of faecal calprotectin measurement on clinical decision-making in patients with Crohn’s disease and ulcerative colitis

Impact of faecal calprotectin measurement on clinical decision-making in patients with Crohn’s disease and ulcerative colitis

Predictive values of stool-based tests for mucosal healing among Taiwanese patients with ulcerative colitis: a retrospective cohort analysis

International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases

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