Introduction An accurate clinical assessment of disease activity in inflammatory bowel disease (IBD) is essential to provide appropriate management strategies. The concurrent presence of functional symptoms in IBD patients is common and said to occur in 80% of proctitis patients, 60% of UC patients and 40% of Crohn’s patients.1 A high symptom index can strongly influence clinical assessment and expose patients to unnecessary investigations. Faecal calprotectin (FC) has a high negative predictive value of 96% for inflammation therefore allowing use in this cohort to differentiate functional and organic symptoms.2
Methods All FC data over a 2 year period was collected in IBD outpatients with a diagnostic uncertainty about symptoms being functional or organic in nature and whether further endoscopic examination was necessary. FC results were regarded as normal (<50 μg/g), borderline (50–100 μg/g) or positive (>100 μg/g) and correlated with endoscopic assessment and subsequent influence on management.
Results 262 FC measurements were performed in IBD patients where there was diagnostic uncertainty about symptoms being organic or functional in origin. In this cohort, unnecessary colonoscopy was spared in 83% (218/262), including 62/66 with normal FC, 26/27 borderlines and 130/169 positives.
Despite a normal FC, 4 patients underwent further assessment via colonoscopy for routine surveillance with no evidence of active disease. In addition, some patients were investigated with CT colonography as an alternative assessment method. 0/2 scans in the borderline group showed positive findings with 6 being performed in the positive FC group. Of these, 5 had active disease with 1 showing a psoas abscess requiring inpatient treatment.
As a result of a positive FC, a direct change in management was made in 114/169 (67%) without the need for further endoscopy. In the case of a negative FC result, 14/66 (21%) patients had an alteration in their treatment regimes to focus upon targeting functional bowel symptoms.
Conclusion Faecal calprotectin measurement spared 80% of the colonoscopies being considered to assess symptomatic IBD patients. Both positive and negative results had a strong influence on subsequent management. FC measurement provides clinicians the confidence to isolate and manage functional symptoms in their IBD cohort, whilst preventing unnecessary treatment escalation. In those with a positive FC result, appropriate treatment could be initiated whilst avoiding the increased risks of endoscopy in acutely inflamed patients.
References 1 Keohane, et al. Am J Gastroenterol. 2010 Aug;105(8):1788, 1789–94
2 Turvill, High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease. Frontline Gastroenterology 2012;3:21–28
Disclosure of Interest None Declared.
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