Introduction The new faecal calprotectin (FC) assessment kits are capable of differentiating between organic and functional bowel disease with a 93% sensitivity and 96% specificity (Rheenen. BMJ.2010). Where the diagnosis is unclear, FC can be used to spare unnecessary invasive colonoscopy. Functional (Irritable bowel syndrome - IBS) symptoms occur in 60% of ulcerative colitis (UC) and 40% of Crohn’s disease patients (Keohane. AJG. 2010). This can cause a notoriously difficult management dilemma, which in turn can lead to over treatment of presumed flares in the inflammatory bowel disease (IBD).
Objectives 1) To assess the ability of FC in differentiating between functional and organic disease where the diagnosis was uncertain, and to review the number of potentially unnecessary colonoscopies that could be spared. 2) To assess the management outcome in symptomatic IBD patients when using FC to determine IBS from inflammatory symptoms.
Methods Over a 6month period FC data was collected from both new gastroenterology referral patients and known IBD patients, where a colonoscopy was being considered because of diagnostic uncertainty about whether they were suffering from organic or functional (IBS) symptoms. A retrospective review was them performed to assess the diagnostic and management outcome.
Results In total 100 FC assessments were performed in new referral patients and 44 in known IBD patients where there had been a diagnostic dilemma. In the new patients colonoscopy was spared in 70% (70/100), including 55/63 with normal FC (< 60), 6/7 with borderline FC (60–100), and 9/30 with high FC (> 100). Some of these patients did however opt for a CT cologram were positive findings were seen in 0/6 of those with normal FC, 1/2 (1 diverticular disease) with borderline FC, and 7 (2 normal, 4 diverticular disease, 1 cancer) with high FC. Despite normal FC results 6 new patients went on to have a colonoscopy, 5 of which were normal and 1 demonstrated a low grade dysplastic tubular adenoma. In the IBD patients colonoscopy was spared in 84% (37/44), including 13/14 with normal FC, 8/9 with borderline FC and 16/21 with high FC. In the IBD cohort the FC changed management in 10/14 with normal results, 4/9 with borderline results and 16/21 with high results.
Conclusion With the increasing demand being made on colonoscopy throughout UK, a greater utilisation of faecal calprotectin into clinical practise could help safely relieve some of this burden. Faecal calprotectin can be strongly influential in the management of known IBD patients, and provides confidence for clinicians to focus in on treating functional bowel symptoms and tailor down escalating management regimes in those with normal results.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.