Introduction Altered bowel habits (ABH) is one of the commonest reasons for referral to the gastroenterology clinic. The spectrum of organic and functional bowel symptoms provides a diagnostic dilemma. Functional bowel disorders are common, occurring in 15–20% of Western populations.1 Therefore, it is important not to create an economic burden by over-investigation.
Faecal calprotectin (FC) is a protein released from neutrophilic leucocytes into the intestinal lumen in response to mucosal inflammation. It is a well-validated, non-invasive test that can differentiate between organic and functional bowel disease with 93% sensitivity and 96% specificity.2 These features make FC measurement a useful objective test in guiding further investigations.
Methods Over a 2 year period, all FC data was collected in new patients referred to the outpatient clinic for further assessment of ABH and where a diagnostic dilemma existed. Results were recorded as normal (<50 μg/g), borderline (50–100 μg/g) or positive (>100 μg/g) and correlated with the use of further endoscopic or radiological assessment. Department of Health (DoH) tariffs were used to assess cost burden and potential savings.
Results 275 FC measurements were performed in new referrals where there was a dilemma about diagnosis or need for further investigation. Colonoscopy was spared in 71% (196/275), including 139/164 normals, 16/22 borderline and 35/89 positives.
Despite a normal FC result, 25 patients underwent endoscopic investigation after initial assessment. Of these, 16 procedures were normal, 4 had diverticular disease and 2 had low grade dysplastic polyps. Some patients underwent CT colonography with positive findings in 4/17 of the normal FC group (3 diverticular disease, 1 incidental gastric malignancy), 0/2 with borderline FC and 8/15 with positive FC measurement (5 diverticular disease, 1 suspected ileal ulcer, 2 cancers).
If all 275 patients had undergone colonoscopy the cost for the Clinical Commissioning Group (CCG) would be £154275. Risk stratifying with FC assessment reduced this to £44319, saving £109956.
Conclusion Faecal calprotectin assessment saved 71% of possible colonoscopies in those new patients assessed for ABH where there was a dilemma as to whether endoscopic investigation was necessary. This provided clinicians with the confidence to diagnose and manage functional bowel symptoms earlier. FC testing also saved our CCG £109956 of potentially unnecessary colonoscopy with the simultaneous advantage of reducing endoscopy waiting times.
Drossman et al. Irritable bowel syndrome. A technical review for practice guideline development. Gastroenterology1997;112:2120–2137
Van Rheenen et al. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010;341:c3369
Disclosure of Interest None Declared.