Precisión diagnóstica de la calprotectina fecal para predecir una colonoscopia patológica

Sánchez, Martínez; González, Raúl; Flores, Eva Iglesias; Camacho, Francisco Gómez; Juanena, Luis Casais; Ruíz, Ana Cristina; Pérez-Barquero, Manuel Montero; Muntané, Jordi; Vega, Juan Francisco

doi:10.1157/13090002

Cited by 21 publications

(8 citation statements)

References 27 publications

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“…Seven patients belonging to this group routinely used aspirin and/or NSAIDs, as well as proton pump inhibitors (such as omeprazole), which can cause side effects in the form of diarrhea, constipation and nausea. This increase in fCal, secondary to the known capacity of these drugs to cause gastrointestinal damage, has already been described [ 29 - 32 ], and Garcia-Sanchez et al [ 33 ] also observed considerably elevated mean fCal values for these reasons. According to the National Institute of Clinical Excellence (NICE) guidelines [ 34 ], fCal values of between 50 and 150 or 200 µg/g may be regarded as representative of mild organic disorders such as remitting IBD, NSAIDs-related inflammation or mild diverticulitis [ 24 , 35 ].…”

Section: Discussionsupporting

confidence: 53%

“…According to the National Institute of Clinical Excellence (NICE) guidelines [ 34 ], fCal values of between 50 and 150 or 200 µg/g may be regarded as representative of mild organic disorders such as remitting IBD, NSAIDs-related inflammation or mild diverticulitis [ 24 , 35 ]. Patients with diverticulitis may present an acute inflammatory component that could explain the discrete increase in the levels of this marker in these individuals [ 22 , 23 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Fecal Calprotectin: A Comparison of Two Commercial Enzymoimmunoassays and Study of Fecal Extract Stability at Room Temperature

et al. 2018

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BackgroundThe aims of the study were: 1) to compare the fecal calprotectin (fCal) assay results with Calprolab™ ELISA (HRP) (Calpro AS) versus our routine method, Elia™ fluoroenzymoimmunoassay (Thermo Fisher), and 2) to determine whether the fCal assay results do not vary following storage of the extract at room temperature for 4 days with the Calpro AS buffer, this being the estimated shipment time from the home of the patient, and an aspect little studied to date.MethodsThe fCal was determined in 198 patients divided into three groups: inflammatory bowel disease (IBD), organic intestinal disease, and functional intestinal disorders. Fecal extraction was carried out using the Roche Diagnostics kit with the corresponding specific buffers.ResultsThe fCal assay with the Thermo Fisher method was found to be more sensitive but less specific than with the Calpro AS technique. The positive predictive value was low (just over 50%), though the negative predictive value was high (over 90%) with both methods. The likelihood ratios revealed small but occasionally important pre- versus post-test differences. When we compared the two methods, the Spearman correlation coefficient (ρ) was 0.819 (95% CI: 0.768 - 0.860) (P < 0.0001), reflecting a positive correlation. Similarly, when stratifying the fCal results into < 50 µg/g, 50 - 100 µg/g and > 100 µg/g, the resulting Cohen’s kappa coefficient was 0.7766 (95% CI: 0.7025 - 0.8507), reflecting a substantial agreement between both methods. The stability of fCal was high in fecal extracts with the Calpro AS extraction buffer at room temperature for 4 days, which yielded a Spearman correlation coefficient of 0.951 (95% CI: 0.933 - 0.965), when the results were compared to those of the recent extracts (P < 0.0001).ConclusionsA positive correlation was observed between the two methods. In view of the high negative predictive value obtained with fCal, the presence of organic disease is highly unlikely in the presence of a normal concentration of this marker. We also confirmed the excellent stability of fCal in fecal extracts with the Calpro AS extraction buffer stored at room temperature. Thus, and for the sake of convenience and hygiene, it would be ideal for the patient to perform the extraction at home.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Fecal Calprotectin: A Comparison of Two Commercial Enzymoimmunoassays and Study of Fecal Extract Stability at Room Temperature

et al. 2018

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“…Disappointingly, these are non-specific markers of bowel inflammation as their levels are also abnormal in NSAID-induced bowel inflammation, celiac sprue, colonic polyps, diverticulitis and colorectal cancer [47], [48]. Moreover, the predictive value of fecal calprotectin for clinical relapse was poor in case of CD compared to UC [49], [50].…”

Section: Discussionmentioning

confidence: 99%

An Investigation of Fecal Volatile Organic Metabolites in Irritable Bowel Syndrome

et al. 2013

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Diagnosing irritable bowel syndrome (IBS) can be a challenge; many clinicians resort to invasive investigations in order to rule out other diseases and reassure their patients. Volatile organic metabolites (VOMs) are emitted from feces; understanding changes in the patterns of these VOMs could aid our understanding of the etiology of the disease and the development of biomarkers, which can assist in the diagnosis of IBS. We report the first comprehensive study of the fecal VOMs patterns in patients with diarrhea-predominant IBS (IBS-D), active Crohn's disease (CD), ulcerative colitis (UC) and healthy controls. 30 patients with IBS-D, 62 with CD, 48 with UC and 109 healthy controls were studied. Diagnosis of IBS-D was made using the Manning criteria and all patients with CD and UC met endoscopic, histologic and/or radiologic criteria. Fecal VOMs were extracted by solid phase microextraction (SPME) and analyzed by gas chromatography-mass spectrometry (GC-MS). 240 VOMs were identified. Univariate analysis showed that esters of short chain fatty acids, cyclohexanecarboxylic acid and its ester derivatives were associated with IBS-D (p<0.05), while aldehydes were more abundant in IBD (p<0.05). A predictive model, developed by multivariate analysis, separated IBS-D from active CD, UC and healthy controls with a sensitivity of 94%, 96% and 90%; and a specificity of 82%, 80% and 80% respectively (p<0.05). The understanding of the derivation of these VOMs may cast light on the etiology of IBS-D and IBD. These data show that fecal VOMs analyses could contribute to the diagnosis of IBS-D, for which there is no laboratory test, as well as IBD.

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“…Damms and Bischoff, 9 in 18 patients, have shown that the mean FC level in those with active IBD was 797. Mdel et al, 10 in 25 patients with IBD, suggested a cut-off of 217 μg/g to determine remission of IBD. In this study of 148 individuals, we have shown the optimal cut-off to be 250 μg/g with 90% sensitivity and an AUROC of 0.93.…”

Section: Discussionmentioning

confidence: 99%

Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-offs should we apply?

Dhaliwal

Zeino

Tomkins

et al. 2014

Frontline Gastroenterol

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BackgroundFaecal calprotectin (FC), a cytosolic protein released by neutrophils (S100 family) in response to inflammation, is a simple, non-invasive test that can be used to differentiate irritable bowel syndrome (IBS) with inflammatory bowel disease (IBD), where there can be considerable symptom overlap.Aims and methodsThe aims of the study were (1) to be able to predict the ability of FC to exclude IBD and determine cut-offs when in remission, (2) to investigate the effects of time and temperature on stability of FC and (3) compare three ELISA kits to measure FC: Buhlmann, PhiCal v1 and PhiCal v2. A total of 311 patients with altered bowel habit were tested for FC; 144 with IBS, 148 with IBD and 19 with other organic causes.ResultsSensitivity and specificity of FC (with PhiCal v2 kit) to distinguish between functional disorder (IBS) and IBD using cut-off 50 μg/g were 88% and 78%, respectively, with a negative predictive value of 87%. Area under the receiver operating curve was 0.84 (CI 0.78 to 0.90). For those with IBD, FC values below 250 μg/g corresponded with remission of disease with a sensitivity and specificity of 90% and 76%, respectively. Area under the receiver operating curve was 0.93 (CI 0.89 to 0.97). FC was stable once extracted and frozen for up to 2.5 months. Pearson correlation was good between Buhlmann assay and PhiCal v2 (r2 = 0.95).ConclusionsFC has up to 87% negative predictive value to exclude IBD, and cut-offs less than 250 μg/g had 90% sensitivity to determine remission in IBD. Once frozen, FC is stable and the ELISA monoclonal plates were broadly comparable.

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Precisión diagnóstica de la calprotectina fecal para predecir una colonoscopia patológica

Cited by 21 publications

References 27 publications

Fecal Calprotectin: A Comparison of Two Commercial Enzymoimmunoassays and Study of Fecal Extract Stability at Room Temperature

Fecal Calprotectin: A Comparison of Two Commercial Enzymoimmunoassays and Study of Fecal Extract Stability at Room Temperature

An Investigation of Fecal Volatile Organic Metabolites in Irritable Bowel Syndrome

Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-offs should we apply?

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