Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

Abstract

A growing body of evidence has been published about the usefulness of measuring calprotectin in faecal samples (FCAL) in inflammatory bowel disease (IBD) assessment, including diagnosis, monitoring of disease activity and relapse prediction. Several systematic reviews with meta-analyses compiling studies for each particular clinical setting have been carried out in recent years. Most of these were focused on the use of FCAL in IBD diagnosis and showed a relevant role for this marker in selecting patients with gastrointestinal symptoms who would not need a further examination by endoscopy. Although a lesser number of meta-analyses have been performed on the use of FCAL as a surrogate marker of disease activity, a close correlation between FCAL and endoscopic activity of IBD has been shown. With respect to the predictive capacity of FCAL for IBD relapse, a single meta-analysis published indicates that this role is more limited. Furthermore, FCAL thresholds vary considerably depending on the clinical setting and, what is more concerning, among different commercially available assays due to a lack of FCAL concentration interchangeability. Here, we summarise recent publications about the role and limitations of FCAL in IBD, with a special focus on meta-analyses, and give an overview of alternative faecal biomarkers.

Biochemical Biomarkers of Mucosal Healing for Inflammatory Bowel Disease in Adults

“…FC may be elevated in many pathological conditions, such as gastrointestinal infections, gastric and colonic malignancies, eosinophilic colitis, lymphocytic colitis, and coeliac disease [ 82 ]. For instance, in a group of 870 outpatients referred for colonoscopy, an increased level of FC was demonstrated in 85% of patients with colorectal cancer and in 81% of patients with inflammatory conditions [ 83 ].…”

Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study

“…However, we should be cautious about a high diagnostic accuracy of the used test in our study and admit its limitation in determining who should be referring for invasive procedures to verify the IBD diagnosis. The FCAL test is concentration-sensitive, so the sensitivity and specificity of the test could vary based on the used threshold, which has its advantages and disadvantages [ 9 , 32 - 34 ]. Furthermore, since we used a single FCAL test and did not investigate further negative FCAL cases for IBD present to rule out the diagnosis, we could miss a few IBD cases.…”

“…Therefore, the single FCAL test diagnostic accuracy could be overestimated in our study. Likewise, the usage of the single FCAL test might miss a few true cases but it could prevent many people from unnecessary costly invasive procedures and patient discomfort [ 34 ].…”

“…Likewise, the usage of the single FCAL test might miss a few true cases but it could prevent many people from unnecessary costly invasive procedures and patient discomfort. 34 This is the first report on the prevalence of IBD with a verified diagnosis in Central Asia. The age-and sex-adjusted prevalence of UC was 84.4 (95% CI, 44.8-123.9) per 100,000 population and CD was 29.5 (95% CI, 8.2-50.9) per 100,000 population.…”

“…The FCAL test is concentration-sensitive, so the sensitivity and specificity of the test could vary based on the used threshold, which has its adwww.irjournal.org vantages and disadvantages. 9,[32][33][34] Furthermore, since we used a single FCAL test and did not investigate further negative FCAL cases for IBD present to rule out the diagnosis, we could miss a few IBD cases. Therefore, the single FCAL test diagnostic accuracy could be overestimated in our study.…”