Clinical utility and diagnostic accuracy of faecal calprotectin for IBD at first presentation to gastroenterology services in adults aged 16–50years

Abstract

Background:Distinguishing inflammatory bowel disease (IBD) from functional gastrointestinal (GI) disease remains an important issue for gastroenterologists and primary care physicians, and may be difficult on the basis of symptoms alone. Faecal calprotectin (FC) is a surrogate marker for intestinal inflammation but not cancer.Aim:This large retrospective study aimed to determine the most effective use of FC in patients aged 16–50 presenting with GI symptoms.Methods:FC results were obtained for patients presenting to the GI clinics in Edinburgh between 2005 and 2009 from the Edinburgh Faecal Calprotectin Registry containing FCs from >16,000 patients. Case notes were interrogated to identify demographics, subsequent investigations and diagnoses.Results:895 patients were included in the main analysis, 65% female and with a median age of 33 years. 10.2% were diagnosed with IBD, 7.3% with another GI condition associated with an abnormal GI tract and 63.2% had functional GI disease. Median FC in these three groups were 1251, 50 and 20 μg/g (p < 0.0001). On ROC analysis, the AUC for FC as a predictor of IBD vs. functional disease was 0.97. Using a threshold of ≥ 50 μg/g for IBD vs. functional disease yielded a sensitivity of 0.97, specificity of 0.74, positive predictive value of 0.37 and negative predictive value of 0.99. Combined with alarm symptoms, the sensitivity was 1.00.Conclusions:Implementation of FC in the initial diagnostic workup of young patients with GI symptoms, particularly those without alarm symptoms, is highly accurate in the exclusion of IBD, and can provide reassurance to patients and physicians.

Integrative epigenome-wide analysis demonstrates that DNA methylation may mediate genetic risk in inflammatory bowel disease

“…Such a non-invasive peripheral blood biomarker could be used to stratify patients to further intrusive investigations (e.g., colonoscopy). Existing clinically available biomarkers such as faecal calprotectin50 already provide similar utility but are unable to distinguish the two forms of IBD. A different 19-probe methylation-based panel can discriminate CD and UC, potentially facilitating clinical decision-making where the medical and surgical management of the two diseases differ.…”

Fecal calprotectin in inflammatory bowel diseases: update and perspectives

“…Few studies illustrate the longitudinal course of fecal calprotectin in the evolution of the disease, and predictive or decision cut-off level differ according to the authors [55,60]. Tibble et al reported that elevated calprotectin level (cut-off level 50 mg/L) showed good predictive value for clinical relapse during the following 12-month period [55].…”

“…In a large study including 900 patients, Kennedy et al evidenced a sensitivity of 0.97, a specificity of 0.74, an NPV of 0.99, using a threshold of ≥ 50 μg/g for IBD vs. functional disease [60].…”

Effect of faecal calprotectin assay variability on the management of inflammatory bowel disease and potential role of faecal S100A12

“…Furthermore, f-Cp is more sensitive and specific for IBD than routinely used systemic inflammatory markers and clinical indices,2–4 6 7 14 17 26–33 and its levels correlate with the degree of neutrophilic infiltration1 4 14 32 as well as endoscopic and histological assessment of disease activity 2 4 5 7 14 27 29–31 33. A study of 895 unselected patients designed to mimic a ‘real world’ undiagnosed patient population reported a sensitivity and specificity of 95% and 75% 17. F-Cp may also be a useful tool for monitoring disease activity and response to therapy and predicting relapse and risk of bowel resection 1–9…”