The Routine Use of Fecal Calprotectin in Clinical Pediatric Practice: Almost there or Still Issues to Address?

Objectives: Pediatric inflammatory bowel disease (IBD) is a complex inflammatory condition of the gut. Diagnosing IBD involves distinct longitudinal periods from first symptoms to primary care assessment, tertiary care referral, and then endoscopic confirmation. The term diagnostic delay (DD) is used if these periods are prolonged. The aim of this review was to amalgamate DD data for children with IBD, and identify factors associated with prolonged DD. Methods: Six health literature databases were searched (December 2020). Inclusion criteria for papers were children diagnosed with IBD before the age of 18 years, DD central tendency data, and to report a central tendency of their DD data, cohort >10 children. For analysis, all data were weighted by cohort sample size. Results: Searches identified 236 papers, and 26 were included in the final analysis with a pooled cohort of 7030 children. The overall DD periods were IBD 4.5 months [Interquartile range (IQR) 3.6–8.7 months], Crohn disease (CD) 5 months (IQR 4–7.2 months), and ulcerative colitis/indeterminate colitis/IBD-unclassified (UC/IC/IBDU) 3 months (IQR 2.2–4.9 months). The difference between subtypes was significant (P < 0.001), with shorter DD for UC/IC/IBDU than CD (P < 0.001) and IBD (P < 0.001). DD periods were longer for CD than IBD (P < 0.001). DD decreased over time for IBD (P < 0.001) and UC (P < 0.001) but the trend suggested an increase for CD (P 0.069). Conclusions: This data can be used to benchmark DD for children with IBD. Individual centers could determine whether improvements to awareness or infrastructure may reduce DD in order to minimize the risk of poor outcomes.

Section: Discussionmentioning

confidence: 99%

Systematic Review of Diagnostic Delay for Children With Inflammatory Bowel Disease

Vernon‐Roberts

Aluzaite

Khalilipour

et al. 2022

“…FC concentration was measured in samples using the CALPROLAB Calprotectin ELISA (Calpro, Lysaker, Norway) kit (4). The lower detection limit of the assay is 25 mg/kg.…”

Section: Methodsmentioning

confidence: 99%

Faecal Calprotectin in Treated and Untreated Children With Coeliac Disease and Juvenile Idiopathic Arthritis

Biskou

Gardner‐Medwin

Mackinder

et al. 2016

Self Cite

This study aimed to provide evidence on whether children at risk of gastrointestinal inflammation have increased measurements of faecal calprotectin (FC). Faecal calprotectin was measured in 232 children; 55 children (n=11 treatment naïve) with juvenile idiopathic arthritis (JIA), 63 with coeliac disease (CD); 17 with new diagnosis before and after treatment on gluten free diet and 114 controls. None of the treatment-naive children with JIA had raised FC. Four JIA patients on treatment had a raised FC but in all cases a repeat test was normal. In newly diagnosed CD patients, the median (IQR) FC was higher 36.4 (26-61) than in controls 25.0 (23-41) mg/kg (p=0.045) but this significantly decreased 25 (25-25) mg/kg (p=0.012) after six months on gluten free diet. Random measurements of FC are not raised in children with JIA or CD. A significant elevation of FC in these groups is not explained by their diagnosis and therefore needs further investigation.

“…Regarding rapid home tests, it has been shown that results from laboratory-performed extraction and patient-performed extraction correlate significantly (33,34). Bourdillon et al (35) has shown that absolute FC concentrations measured by different kits, even produced by the same manufacturer, may not be comparable. As a consequence, for results to be comparable, it is highly advised to use the same extraction methodology and test kit for follow-up and disease activity monitoring in the same patient over time (35,36).…”

Section: Calprotectin Measurementmentioning

confidence: 99%

The Use of Fecal Calprotectin Testing in Paediatric Disorders

Köninckx

Aliaga

Benninga

et al. 2021

Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.