Introduction Calprotectin is an abundant neutrophil protein that is released during inflammation. The level of faecal calprotectin (FC) is useful in differentiating inflammatory bowel disease (IBD) from non-organic functional bowel disorders. FC may also be useful in monitoring patients with IBD to identify acute flares in disease, long before the patient becomes symptomatic. This allows appropriate treatment to be given in situations where disease activity is objectively measured to be greater than any perceived deterioration in symptoms.
Methods Faecal calprotectin data was collected over a 2 year period from 110 patients with IBD, who underwent regular out-patient assessment. Results were recorded as normal (<50 µg/g), borderline (50–100 µg/g) and elevated (>100 µg/g). A retrospective analysis of management outcome was made from reviewing patient records on the local clinical correspondence store and the new National IBD-Registry.
Results 44, 5 and 61 patients had normal, borderline and elevated FC levels, respectively. Three patients with normal FC (6.8%), compared to 29 (47.5%) with elevated FC, required up-regulation of their management for symptom control. FC returned to normal levels in those selected for treatment escalation. In total, 104/110 (94.5%) of patients avoided investigative colonoscopy. Six patients did require colonoscopic assessment, 1 had normal FC, 1 was borderline and 4 had elevated FC. Three of these 6 colonoscopic examinations were performed as part of surveillance and 2 were carried out in FC +ive patient, 1 for planned therapeutic dilatation of a known stricture and the other to confirm the severe and extent of their disease prior to referral for surgical intervention.
Conclusion FC is a useful monitoring tool in IBD and in identifying those who have developed or are about to suffer an acute flare in their disease. This allows adjustment of treatment without having to subject patients to colonoscopic investigation. A positive result directs the need to upregulate management, whilst a negative one can be reassuring, allowing physician to concentrate on treating functional aspects if the patient is symptomatic.
Disclosure of Interest None Declared.
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