Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta‐analysis

Abstract

Objectives To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs). Study design Studies that assessed the accuracy of FC testing for differentiating between IBD or organic GID and functional GIDs were reviewed. Articles published in English during January 1998 – June 2018 that compared diagnostic FC testing in primary care and outpatient hospital settings with a reference test and employed the standard enzyme‐linked immunosorbent FC assay method with a cut‐off of 50 or 100 μg/g faeces were included. Study quality was assessed with QUADAS‐2, an evidence‐based quality assessment tool for diagnostic accuracy studies. Data sources MEDLINE and EMBASE; reference lists of screened articles. Data synthesis Eighteen relevant studies were identified. For distinguishing patients with organic GID (including IBD) from those with functional GIDs (16 studies), the estimated sensitivity of FC testing was 81% (95% CI, 74–86%), the specificity 81% (95% CI, 71–88%); area under the curve (AUC) was 0.87. For distinguishing IBD from functional GIDs (ten studies), sensitivity was 88% (95% CI, 80–93%), specificity 72% (95% CI, 59–82%), and AUC 0.89. Assuming a population prevalence of organic GID of 1%, the positive predictive value was 4.2%, the negative predictive value 100%. The difference in sensitivity and specificity between FC testing cut‐offs of 50 μg/g and 100 μg/g faeces was not statistically significant (P = 0.77). Conclusions FC testing is clinically useful for distinguishing organic GID (including IBD) from functional GIDs, and its incorporation into clinical practice for evaluating patients with lower gastrointestinal symptoms could lead to fewer patients with functional GIDs undergoing colonoscopy, reducing costs for both patients and the health system. PROSPERO registration CRD4201810507.

Aeromedical retrievals for gastrointestinal disorders in rural and remote Australia: the need for improved access to specialist advice

“…GI disorders are very common in Australia with estimates indicating that half the population complain of digestive problems . GI disorders comprise a wide range of conditions, including functional GI disorders such as constipation and irritable bowel syndrome (IBS), and structural GI disorders such as peptic ulcers, reflux, colonic polyps and cancer, and inflammatory bowel disease (IBD) . Many GI conditions require specialist assistance for diagnosis and management.…”

Inpatient usage of faecal calprotectin in a tertiary hospital

“…[4][5][6] It has been shown to be cost-effective in this setting by decreasing the number of colonoscopies performed with meta-analyses suggesting it could reduce the number of colonoscopies by 67% in adult patients. 7,8 It is not recommended for those over the age of 50 years due to concern for malignancy. 8 There are also confounding factors for FCP testing, including NSAID usage and gastrointestinal infection.…”

“…8 There are also confounding factors for FCP testing, including NSAID usage and gastrointestinal infection. 7 FCP has a role in the management of IBD allowing a non-invasive measure of disease activity, and can also be used to predict relapses, as well monitor response to treatment. 9,10 Similarly to its use in primary care, it aims to reduce the number of colonoscopies performed and has been shown to be cost-effective in this setting.…”

Utility of faecal calprotectin testing in dermatology

“…Faecal calprotectin testing is a noninvasive test to help distinguish inflammatory from noninflammatory bowel disorders as it has a high sensitivity and specificity for bowel inflammation 2 . However, it should also be noted that it has an extremely high negative predictive value 2 and therefore inflammation of the bowel is unlikely if a negative result (< 50 µg/g) is obtained 1,2 . Based on this, the main utility of FCP testing in dermatology practice may not be in its use in patients with a high probability of IBD who will require further investigation by Gastroenterology, but in those who are less likely to have bowel inflammation, as a negative result will make bowel inflammation unlikely.…”

“…Faecal calprotectin testing is a noninvasive test to help distinguish inflammatory from noninflammatory bowel disorders as it has a high sensitivity and specificity for bowel inflammation 2 . However, it should also be noted that it has an extremely high negative predictive value 2 and therefore inflammation of the bowel is unlikely if a negative result (< 50 µg/g) is obtained 1,2 .…”