Elevated Faecal Calprotectin Does Not Differentiate Between Inflammatory Bowel Disease and a Juvenile Polyp

Abstract

with great interest the article by Bjo ¨rck et al (1). The authors concluded that repeated screening using tissue transglutaminase antibodies is necessary to identify new cases of coeliac disease (CD) by 9 years of age. Furthermore, they affirm that CD screening can be restricted to children carrying HLA-DQ2 and/or DQ8.I would like to point out that the age of 9 years is perhaps a critical age from the evolutionary point of view. In my opinion, the gluten-free diet may be more accepted in earlier stage, during entry into primary school (2). In order to achieve effective guidelines, it is useful to make a rationalization of instruments useful for diagnosis.It has been demonstrated that when the pretest probability of CD is low, patients with positive tissue transglutaminase serology should undergo oesophagogastroduodenoscopy with biopsyeither directly or after positive screening for HLA DQ2/8-to confirm CD. ( 3).It appears that the awareness of genetic testing (GT) is high among CD support group members. Efforts should be made to increase the knowledge of GT in those with a lower educational level, and health care professionals should attempt to address the concerns regarding GT cost and the impact of results on health care and insurance status (4).In conclusion, I wish to advocate the need for GT in population, but to suggest that targeted screening programs in the early stages of childhood should be organized to get the best possible adherence to the gluten-free diet.

Fecal Amino Acid Analysis Can Discriminate De Novo Treatment‐Naïve Pediatric Inflammatory Bowel Disease From Controls

“…Various biomarkers have been evaluated as tool in the diagnostic work-up for IBD, with fecal calprotectin (FCP) showing the highest sensitivity for detection of mucosal inflammation (0.98, 95% confidence interval 0.95-0.99) (7). Fecal calprotectin is, however, characterized by a relative low specificity (0.68, 95% confidence interval 0.50-0.86), limiting its use to differentiate between IBD and other gastrointestinal diseases, such as polyps and infectious gastroenteritis (8)(9)(10). Other widely studied biomarkers include metabolic products, which may potentially have a higher specificity for IBD detection, because they reflect (patho)physiological processes involved in IBD pathogenesis (11).…”

Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

“…Fecal calprotectin, which is excreted by migrating neutrophils to the lumen of the inflamed bowel, has been demonstrated a useful surrogate marker for disease activity in both children and adults [18,21,22,31,32]. However, FC is not specific to inflammatory bowel disease and may increase in the presence of other gastrointestinal disorders, such as infectious colitis and polyposis [33,34]. In addition, bowel leaks and abscesses may raise the level of FC for several weeks and complicate its interpretation in the postoperative setting [27].…”

Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice

“…Studies have demonstrated greater efficiency of calprotectin in diagnosis of IBD in children than in adults [19]. The presence of high levels of FC was evidenced in the course of IBD [8, 20]. The first reports of this observation appeared in the 1990s; a positive correlation was observed between the calprotectin level and the intensity of inflammatory lesions in the intestines [10, 21, 22].…”

“…However, when examining patients with symptoms suggesting the presence of irritable bowel syndrome (IBS), it was stated that in 1/3 of patients, the value of calprotectin was >50 µg/g; eventually, 28% of them were diagnosed with organic intestinal disease, whereas in the group of patients with a calprotectin level <50 µg/g, organic intestinal disease was diagnosed in only 3% of patients [10, 12, 24]. Studies have been conducted on the determination of calprotectin levels that would prompt referral for endoscopy and allow for diagnosis of disease exacerbation in IBD patients [8, 16, 20, 25]. Van de Vijver et al [9] propose that a calprotectin cutoff point of 50 µg/g helps avoid endoscopy in 20% of children with gastrointestinal symptoms suggesting IBD, whereas with the increase in the cutoff point value to >150 µg/g, the number of patients referred for endoscopic examination in the group of people with IBD symptoms would decrease by an additional 7% [5, 12].…”