Is fecal calprotectin always normal in children with irritable bowel syndrome?

Abstract

Background/AimsFecal calprotectin (FC) is a marker of intraluminal intestinal inflammation. Intestinal inflammation may contribute to the pathophysiology of irritable bowel syndrome (IBS). This study evaluated FC levels in children with IBS and differences in FC levels in children stratified by IBS subtype and healthy controls (HCs).MethodsA total of 157 children with IBS and 56 HCs aged 4–16 years (119 boys, 94 girls, mean age of 9.48 years) were included in this prospective study. Children with IBS were diagnosed using the Rome III criteria and classified into 4 subtypes: IBS with constipation (IBS-C, n=37), IBS with diarrhea (IBS-D, n=54), IBS with alternating constipation and diarrhea (IBS-M, n=49), and IBS unsubtyped (IBS-U, n=17); postinfectious IBS (PI-IBS) was also considered. The FC concentration in stool samples was analyzed using an enzyme-linked immunosorbent assay. All participants answered a questionnaire regarding several demographic and clinical characteristics.ResultsChildren with IBS had significantly higher levels of FC than the HCs (88.71 μg/g vs. 17.77 μg/g). Among the 4 IBS subtypes, the FC concentration was highest in children with IBS-D, followed by those with IBS-M, IBS-C, and IBS-U (169.94 μg/g vs. 45.04, 31.22, and 33.52 μg/g, respectively), and these differences were statistically significant. For PI-IBS, 90% of cases were in the IBS-D group.ConclusionsThe FC level was significantly higher in children with IBS than in HCs and differed depending on the IBS subtype, supporting the notion that IBS is a type of low-grade bowel inflammation.

An Update on the Assessment and Management of Pediatric Abdominal Pain

“…While a low calprotectin decreases the chances of IBD (particularly in combination with a low CRP), it does not eliminate IBD from the diagnosis; similarly an elevated calprotectin does not necessarily indicate IBD, particularly in patients with diarrhea-predominant IBS. 55 , 58 , 61 While most studies do not support a relationship between celiac disease and pediatric FAPDs, one Italian study found a 4-fold increase in celiac (4.4% vs 1%) in youth with IBS and another study found a borderline increase. 62 , 63 Both the American Gastroenterological Association (AGA) and the pediatric Rome committee have recommended celiac screening in IBS.…”

“…54 Serum C-reactive protein (CRP) and stool calprotectin or stool lactoferrin also have utility in indicating IBD including in children and adolescents. [55][56][57][58][59][60] However, results must be interpreted with caution. While a low calprotectin decreases the chances of IBD (particularly in combination with a low CRP), it does not eliminate IBD from the diagnosis; similarly an elevated calprotectin does not necessarily indicate IBD, particularly in patients with diarrhea-predominant IBS.…”

“…While a low calprotectin decreases the chances of IBD (particularly in combination with a low CRP), it does not eliminate IBD from the diagnosis; similarly an elevated calprotectin does not necessarily indicate IBD, particularly in patients with diarrhea-predominant IBS. 55,58,61 While most studies do not support a relationship between celiac disease and pediatric…”

Increasing Evidence That Irritable Bowel Syndrome and Functional Gastrointestinal Disorders Have a Microbial Pathogenesis

“…In addition, a recent study demonstrated that differences in fecal calprotectin concentrations in children discriminated between IBS subtypes and from healthy controls. In particular, fecal calprotectin concentration was highest in IBS-D, followed by those with IBS-M and IBS-C (Choi and Jeong, 2019 ). In combination with other plasma and fecal biomarkers, fecal calprotectin may effectively discriminate IBS from health and within IBS subtypes (Nemakayala and Cash, 2019 ).…”

Association between body mass index and fecal calprotectin levels in children and adolescents with irritable bowel syndrome

“…[ 30 , 31 ] This means that intestinal inflammation may also contribute to the pathophysiology of IBS. [ 11 ] In a study by Choi et al, [ 32 ] fecal calprotectin was used to assess intestinal inflammation in pediatric IBS patients. Fecal calprotectin levels were significantly higher among IBS patients than healthy controls, and the values were distributed in the intermediate range (50–150 µg/g), confirming that IBS was also associated with low-grade bowel inflammation.…”